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2014 ; 2
(4
): E244-51
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Self-Expanding Metal Stent (SEMS): an innovative rescue therapy for refractory
acute variceal bleeding
#MMPMID26135101
Changela K
; Ona MA
; Anand S
; Duddempudi S
Endosc Int Open
2014[Dec]; 2
(4
): E244-51
PMID26135101
show ga
BACKGROUND: Acute variceal bleeding (AVB) is a life-threatening complication of
liver cirrhosis or less commonly splenic vein thrombosis. Pharmacological and
endoscopic interventions are cornerstones in the management of variceal bleeding
but may fail in 10?-?15?% of patients. Rescue therapy with balloon tamponade (BT)
or transjugular intrahepatic portosystemic shunt (TIPS) may be required to
control refractory acute variceal bleeding effectively but with some limitations.
The self-expanding metal stent (SEMS) is a covered, removable tool that can be
deployed in the lower esophagus under endoscopic guidance as a rescue therapy to
achieve hemostasis for refractory AVB. AIMS: To evaluate the technical
feasibility, efficacy, and safety of SEMS as a rescue therapy for AVB. METHODS:
In this review article, we have performed an extensive literature search
summarizing case reports and case series describing SEMS as a rescue therapy for
AVB. Indications, features, technique, deployment, success rate, limitations, and
complications are discussed. RESULTS: At present, 103 cases have been described
in the literature. Studies have reported 97.08?% technical success rates in
deployment of SEMS. Most of the stents were intact for 4?-?14 days with no major
complications reported. Stent extraction had a success rate of 100?%. Successful
hemostasis was achieved in 96?% of cases with only 3.12?% found to have
rebleeding after placement of SEMS. Stent migration, which was the most common
complication, was observed in 21?% of patients. CONCLUSION: SEMS is a safe and
effective alternative approach as a rescue therapy for refractory AVB.