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Purpose: To identify predictors associated with clinical outcomes (initial clinical failure, stent patency, and survival) after self-expandable metal stent (SEMS) placement for malignant esophagorespiratory fistulas (ERFs).Materials and Methods: Using logistic and Cox regression analyses, this study reviewed 88 patients (mean age 59.4 y ± 8.4; 84 men [95.5%] and 4 women [4.5%]) who underwent fluoroscopic SEMS placement for palliating malignant ERF from January 2000 to December 2016.Results: Technical success was achieved in all patients. Initial clinical success was achieved in 78.4% (69/88; 95% confidence interval [CI], 68.7%-85.7%). Among the 69 patients in whom initial clinical success was achieved, aspiration symptoms recurred in 37.7% (26/69; 95% CI, 27.2%-49.5%). Overall major complication rate was 25.0% (22/88; 95% CI, 17.1%-35.0%). Cumulative stent patency and cumulative survival rates at 1, 3, 6, and 12 months were 72.8%, 38.9%, 32.4%, and 21.6% and 81.4%, 51.9%, 30.5%, and 13.3%, respectively. Stricture of the upper esophagus was an independent predictor of initial clinical failure (odds ratio, 3.760; 95% CI, 1.207-11.811) and shorter stent patency (hazard ratio [HR], 2.036; 95% CI, 1.170-3.544). Initial clinical failure was an independent predictor of shorter survival (HR, 2.902; 95% CI, 1.587-5.305).Conclusions: SEMS placement offers sufficient short-term relief despite considerable major complications. Stricture of the upper esophagus is an independent predictor of initial clinical failure and shorter stent patency. Initial clinical failure is an independent predictor of shorter survival. [ABSTRACT FROM AUTHOR]

Purpose: To assess the long-term outcomes of covered retrievable self-expandable metallic stent (REMS) placement for recurrent benign urethral stricture and to compare the outcomes associated with 3 types of covered REMSs.Materials and Methods: A retrospective study was performed in 54 male patients in whom 114 REMSs were placed between November 1998 and December 2016. These included 26 polyurethane-covered REMSs in 13 patients (group A), 47 internally polytetrafluoroethylene (PTFE)-covered REMSs in 21 patients (group B), and 41 externally PTFE-covered REMSs in 20 patients (group C). The outcomes were analyzed and compared between the groups.Results: Overall clinical success was achieved in 14 of the 54 patients (24%) at 5-year follow-up (group A, 12%; group B, 19%; group C, 40%). The overall complication rate was 60.5%, and the complication rate was significantly higher in group B than in groups A or C (group A vs B, P = .018; group B vs C, P = .002). The median stent indwelling time and maintained patency period were 3.1 months and 108 months, respectively. In multivariate analysis, stent indwelling time was the only significant factor associated with maintained patency.Conclusions: The long-term outcome of covered REMSs has not achieved the desired success rate for the standard treatment of recurrent urethral stricture. However, externally PTFE-covered REMSs showed a better long-term outcome than the other studied types. [ABSTRACT FROM AUTHOR]

The medical records of 7 patients who underwent percutaneous transparaumbilical embolization of spontaneous portosystemic shunts for treatment of hepatic encephalopathy (HE) were retrospectively reviewed. Technical success was achieved in 100% (7/7) of patients. Four patients had complete resolution and 3 had improvement of signs and symptoms of HE within 3 days after the procedure for a clinical success rate of 100% (7/7). New-onset esophageal varices, a major complication, occurred in 1 patient. No other major complications were encountered. HE recurred in 71.4% (5/7) of patients during a median follow-up period of 43 months (range, 4-111 months). [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the frequency, severity, and clinical significance of stent abutment (SA) after gastroduodenal stent placement in patients with gastric outlet obstruction caused by unresectable gastric cancer.Materials and Methods: A retrospective study was conducted in a single tertiary referral university hospital to identify the incidence and clinical significance of SA in 318 patients who underwent self-expandable metallic stent placement. SA was defined as abutment of the distal end of the stent to the duodenal wall and/or superior duodenal flexure. The outcomes included technical and clinical success, complications, repeat intervention, stent patency, and survival.Results: A total of 318 patients, 107 with SA (33.6%) and 211 without, were included. SA occurred partially (n = 64; 59.8%) and completely (n = 43; 40.2%). The technical and clinical outcomes and survival were similar in the groups with and without SA. Food impaction and resultant repeat intervention rates were higher in the SA group than in the non-SA group (P < .001 and P < .001, respectively), and were associated with complete SA (P = .007). Stent patency rate was lower in the SA group than in the non-SA group (P = .003).Conclusions: SA was associated with increased food impaction, resulting in a greater incidence of stent malfunction and shorter stent patency compared with a lack of SA. The concept of SA may be useful for the improvement of stent patency and avoidance of food impaction. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of transcatheter arterial embolization with N-butyl cyanoacrylate (NBCA) for the treatment of gastrointestinal (GI) bleeding via a meta-analysis of published studies.Materials and Methods: The MEDLINE/PubMed and EMBASE databases were searched for English-language studies from January 1990 to March 2016 that included patients with nonvariceal GI bleeding treated with transcatheter arterial embolization with NBCA with or without other embolic agents. The exclusion criteria were a sample size of < 5, no extractable data, or data included in subsequent articles or duplicate reports.Results: The cases of 440 patients (mean age, 63.8 y ± 14.3; 319 men [72.5%] and 121 women [27.5%]) from 15 studies were evaluated. Of these patients, 261 (59.3%) had upper GI bleeding (UGIB) and 179 (40.7%) had lower GI bleeding (LGIB). Technical success was achieved in 99.2% of patients with UGIB (259 of 261) and 97.8% of those with LGIB (175 of 179). The pooled clinical success and major complication rates in the 259 patients with UGIB in whom technical success was achieved were 82.1% (95% confidence interval [CI], 73.0%-88.6%; P = 0.058; I2 = 42.7%) and 5.4% (95% CI, 2.8%-10.0%; P = 0.427; I2 = 0.0%), respectively, and those in the 175 patients with LGIB in whom technical success was achieved were 86.1% (95% CI, 79.9%-90.6%; P = 0.454; I2 = 0.0%) and 6.1% (95% CI, 3.1%-11.6%; P = 0.382; I2 = 4.4%), respectively.Conclusions: Transcatheter arterial embolization with NBCA is safe and effective for the treatment of GI bleeding. [ABSTRACT FROM AUTHOR]

Objective: To evaluate associations between postnatal imaging features and outcome of left-sided congenital diaphragmatic hernia, as defined by overall survival and a requirement for extracorporeal membrane oxygenation (ECMO).Study Design: Newborns diagnosed prenatally with left-sided congenital diaphragmatic hernia between January 2013 and September 2021 were studied retrospectively. The esophageal deviation index was newly defined as the largest diameter from the midline to deviated gastric tube divided by the largest transverse diameter of the thoracic cavity on the radiograph. Regression analyses were performed to identify postnatal imaging features associated with overall survival and a requirement for ECMO. The predictive power (ie, area under the curve [AUC] of a time-dependent receiver operating characteristic curve) of prenatal, postnatal, and intraoperative findings for predicting survival were calculated.Results: Ninety-seven patients (54 males; mean gestational age, 38.3 ± 1.9 weeks; mean birth weight, 2956.5 ± 540.0 g) were analyzed. The esophageal deviation index (adjusted hazard ratio [HR], moderate [≥0.19 to <0.24], 6.427 [P = .029]; severe [≥0.24], 33.007 [P < .001]) and right pneumothorax (adjusted HR, 8.763; P = .002) were associated with overall survival and with a requirement for ECMO. Liver herniation on postnatal ultrasound also was associated with overall survival (P < .001) and need for ECMO (P = .001). In addition, the AUC for prediction of 1-year survival from postnatal ultrasound was comparable with that of prenatally or intraoperatively detected liver herniation (0.93; 95% CI, 0.88-0.97).Conclusions: The esophageal deviation index, right pneumothorax, and liver herniation observed by postnatal imaging have prognostic value in patients with left-sided congenital diaphragmatic hernia. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To present a well-defined protocol for balloon dilation for colorectal anastomotic strictures and evaluate clinical efficacy of the dilation in 42 patients. Materials and Methods: From October 1999 to June 2010, 42 patients (32 males and 10 females with mean age 52.1 years ± 16.3) with surgical colorectal anastomotic strictures who received transanal balloon dilation using a well-defined protocol were retrospectively investigated. After the procedure, a water-soluble contrast media study was performed to detect possible complications. Stricture diameter was measured 1 month after balloon dilation. Clinical outcomes and recurrence were evaluated with a median follow-up period of 63.7 months. Results: There were 47 dilation sessions performed in 42 patients. Technical success and clinical success were achieved in all patients. At long-term follow-up, 36 (85.7%) patients had complete improvement. No complications were observed in any patients. Stricture diameter 1 month after the procedure was 8.85 cm ± 3.23, which was a significant increase over stricture diameter before the procedure of 5.89 cm ± 2.64 (P < .001), showing increase in diameter by 50.3%. Four (9.5%) patients experienced symptomatic recurrence. Stricture diameter of the patients with recurrence was considerably larger than stricture diameter of other patients (P = .036). Conclusions: Fluoroscopically guided balloon dilation using the protocol described is safe and clinically effective for treatment of colorectal anastomotic stricture. [Copyright &y& Elsevier]

Few data are available to guide the use of anal imaging for patients with Crohn's disease (CD) who are not suspected of having perianal fistulas. We aimed to evaluate the role of anal imaging supplementary to magnetic resonance enterography (MRE) in these patients. In a prospective study, we added a round of anal MR imaging (MRI), collecting axial images alone, to MRE evaluation of 451 consecutive adults who were diagnosed with or suspected of having CD but not believed to have perianal fistulas. Images were examined for perianal tracts; if present, colorectal surgeons reexamined patients to identify external openings or perianal inflammation or abscess. Patients were followed and data were collected on dedicated treatment for perianal fistulas or abscess. We calculated the diagnostic yield for anal MRI, associated factors, and outcomes of MRI-detected asymptomatic perianal tracts. A total of 440 patients (mean age, 29.6±8.9 years) met the inclusion criteria. Anal MRI revealed perianal tracts in 53 patients (12%; 95% CI, 9.3%–15.4%). Surgeons however did not identify any lesions that required treatment. The asymptomatic tracts were mostly single unbranched (83%), inter-sphincteric (72%), or had a linear dark signal at the tract margin (79%). Younger age at MRE, female sex, and CD activity index scores of 220–450 were independently associated with detection of perianal tracts. MRI detection of asymptomatic tracts was independently associated with later development of perianal fistulas or abscess that required treatment: 17.8% cumulative incidence at 37 months and an adjusted hazard ratio of 3.06 (95% CI, 1.01–9.27; P =.048). In a prospective study of patients with CD, we found that adding anal MRI evaluation to MRE resulted in early identification of patients at risk for perianal complications. [ABSTRACT FROM AUTHOR]

Purpose: To perform a systematic review and meta-analysis of published studies to evaluate the efficacy of lymphatic interventions for chylothorax.Materials and Methods: The MEDLINE, EMBASE, and Cochrane databases were searched for English-language studies until March 2017 that included patients with chylothorax treated with lymphangiography (LAG), thoracic duct embolization (TDE), or thoracic duct disruption (TDD). Exclusion criteria were as follows: a sample size of less than 10 patients, no extractable data, or data included in subsequent articles or duplicate reports.Results: The cases of 407 patients from 9 studies were evaluated. The pooled technical success rates of LAG and TDE were 94.2% (95% confidence interval [CI], 88.4%-97.2%; I2 = 46.7%) and 63.1% (95% CI, 55.4%-70.2%; I2 = 37.3%), respectively. The pooled clinical success rates of LAG, TDE, and TDD, on a per-protocol basis, were 56.6% (95% CI, 45.4%-67.2%; I2 = 5.4%), 79.4% (95% CI, 64.8%-89.0%; I2 = 68.1%), and 60.8% (95% CI, 49.4%-71.2%; I2 = 0%), respectively. The pooled major complication rate of LAG and TDE was 1.9% (95% CI, 0.8%-4.3%; I2 = 0%) and 2.4% (95% CI, 0.9%-6.6%; I2 = 26.4%), respectively. The pooled overall clinical success rate of lymphatic interventions, on an intention-to-treat basis, was 60.1% (95% CI, 52.1%-67.7%; I2 = 54.3%). Etiology of chylothorax was identified as a significant source of heterogeneity for the pooled clinical success rate of TDE and overall clinical success rate.Conclusions: Lymphatic interventions have a respectable efficacy for the treatment of chylothorax. [ABSTRACT FROM AUTHOR]