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Background: We aimed to study the safety and efficacy of three tubes with or without covered esophageal stent placement for the management of gastro-mediastinal or gastro-pleural fistula. Methods: We retrospectively assessed the clinical data of 31 consecutive patients with gastro-mediastinal or gastro-pleural fistula treated by using a non-invasive protocol. Patients received three tubes (jejunal feeding tube, gastrointestinal drainage tube and abscess drainage tube) with or without esophageal covered stent placement. All patients received continue abscess drainage and nutritional support after procedure. The tubes and/or esophageal covered stents were removed after fistula healing. Results: All patients received three tubes placement and 11 patients with lumenal narrowing received esophageal covered stent placement. Technically success was found in all patients, with no perioperative death, esophageal rupture or massive hemorrhage. Abscess cavity disappeared in 22 patients, with a clinical success rate of 71.0%. All patients received esophageal stent placement were cured and stents were removed, for the median duration of 1.6 months (IQR 1.4, 3.7). Three patients showed clinical improved, with markedly decreased abscess cavity and markedly shrunk fistula. The median survival was 30.8 months. The 1-, 3-, 5-year survival rates were 71.1%, 46.1% and 39.5%, respectively. Conclusions: A non-invasive protocol of three tubes with or without covered esophageal stent placement is safe and effective for gastro-mediastinal or gastro-pleural fistula after esophagogastrectomy.

Objective: To study the predictive factors of false negatives in the diagnosis of biliary stricture (BS) by percutaneous transluminal clamp biopsy (PTCB). Method: From January 2016 to January 2021, 194 patients with a high suspicion of malignant tumors due to BS underwent PTCB during biliary drainage at our department. The final diagnosis was confirmed by postoperative pathology, other tissue or cell evidence, or medical imaging follow-up. Univariate and multivariate regression analyses were performed on the pathological results, summarizing the independent risk factors for false-negative value (FNV) to help further clinical diagnosis and treatment. Results: Of the 194 cases, 144 and 18 cases were diagnosed as malignant and benign BS, respectively. The sensitivity, specificity, false-positive value and FNV of PTCB were 81.8%, 100%, 0% and 18.2%, respectively. Multivariate analysis showed that noncholangiocarcinoma PS was an independent risk factor for FNV of PTCB [odds ratio 7.5, (95% CI 1.74-32.6), pConclusion PTCB is an effective minimally invasive interventional technique for BS diagnosis. Noncholangiocarcinoma BS is an independent risk factor for FNV.

Background Drug eluting beads transarterial chemoembolization (DEB-TACE) is considered as an effective and safe method in treating hepatocellular carcinoma. CalliSpheres beads (CB) is a novel microsphere product in China. Currently, few studies reported efficacy and safety of DEB-TACE with irinotecan-eluting CB in treating unresectable gastrointestinal cancer liver metastases (GRLM). This study aimed to evaluate the clinical outcomes of DEB-TACE with irinotecan-eluting CB in treating unresectable GRLM. Methods From May 2016 to May 2022, 28 patients with unresectable GRLM who were treated with DEB-TACE with irinotecan-eluting CB procedures were studied. Objective response rate (ORR) and disease control rate (DCR) were primary endpoints, Overall survival and progression-free survival (PFS) were the minor endpoints. Other indexes such as Child-Pugh class, systemic treatments and adverse events were assessed before or after procedure. Results ORR and DCR were 18.2% and 86.4%, respectively, at 1 month; were 27.8% and 61.1%, respectively, at 3 months; then were 21.4% and 50.0%, respectively at 6 months. As for survival profiles, 1-year overall survival was 70.0%; 3-year overall survival was 37.5%; the median overall survival and PFS were 15.2 months and 5.2 months, respectively. No severe adverse events were observed during and after DEB-TACE. The most common complication was abdominal pain (n = 13). Besides, nausea, fever, vomiting were observed in 5, 4 and 5 patients, respectively. Conclusions DEB-TACE with irinotecan-eluting CB is effective and safe, with good tolerance in treating unresectable GRLM.

Background: To investigate the safety and effectiveness of trans-oral trans-sheath forceps biopsy (TTFB) for patients with severe esophageal obstruction under fluoroscopy.Methods: From November 2016 to November 2019, 35 patients with level Ⅲ or Ⅳ dysphagia and a Karnofsky score of less than 60 were enrolled to undergo TTFB and esophageal nutrition tube insertion or stenting simultaneously. Data on diagnostic performance, early complications, and radiation dose were collected, and Karnofsky scores before and after the procedures were compared.Results: The technical success of TTFB was 100%. The sensitivity, specificity and accuracy were 92.3% (24/26), 77.8% (7/9), and 88.6% (31/35), respectively. Complications occurred in two cases (5.7%). The mean procedure duration and irradiation dose were 23.2 min and 7.2 mSv, respectively. The Karnofsky scores significantly increased after 2-4 weeks (t = -8.9, P < 0.01).Conclusions: TTFB is a safe and effective method for patients with severe esophageal obstruction under fluoroscopy, especially in those who cannot undergo or refuse endoscopy.

Background: Migrated esophageal self-expandable metal stents (SEMSs) increase the risk of bowel obstruction or perforation. The endoscopic removal of migrated stents is extremely difficult due to the inability to observe the distal end of the stent during retrieval. Here, we report our experience removing migrated esophageal stents in the stomach under the guidance of fluoroscopy.Material and methods: The clinical data of patients with esophageal stents that migrated to the stomach between January 2016 and March 2020 were analyzed retrospectively. A total of 27 patients (9 females and 18 males) were included in this study. Three methods of retrieval were considered: direct removal via a fixed string, direct removal via a retrieval hook, and retrieval via guide wire and gooseneck snare.Results: A total of 28 migrated esophageal stents in the stomachs of 27 patients were successfully removed under the guidance of fluoroscopy by the three methods mentioned above: 10 cases of direct removal via a fixed string, 14 cases of direct removal via a retrieval hook, and 3 cases of retrieval via a guide wire. The stent removal time was 18 (7-60) minutes. During the operation, one patient had a small amount of esophageal bleeding that was cured after symptomatic treatment, and one patient had a residual fracture stent wire that was removed under endoscopy.Conclusion: The removal of migrated esophageal stents in the stomach under the guidance of fluoroscopy is a feasible and safe procedure.

Background: Endoscopic removal is the most common method for removal of tracheal stents. Few studies have reported the technique of fluoroscopy-guided stent removal for tracheal fistula and tracheal stenosis. We aimed to study the safety and efficacy of fluoroscopy-guided stent removal as well as the optimal duration for stent usage. Methods: We conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Reasons for stent implantation were tracheal fistula in 85 patients (TF group), and tracheal stenosis in 67 patients (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, and survival rate were compared between the two groups. Results: The technical success rate of stent removal was 98.9% and 97.4%, respectively for the TF and TS group. Removal was routine for half of patients, and in the remainder, excessive granulation tissue was the common indications for stent removal, which was found after stenting at 142.1±25.9 days in the TF group, and at 89.9±15.0 day in the TS group. The total incidence of complications was 21.1% and 22.4%, respectively, for the TF and TS groups. Perioperative death occurred in one patient in the TF group, and two patients in the TS group. Recurrence of fistula or stenosis requiring re-stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3%, 59.6%, and 36.1% for TF group, and 80.4%, 75.7%, 75.7% for TS group. Conclusions: Fluoroscopic removal of tracheal stents is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference in outcomes. Clinicians should pay attention to the risk of hemoptysis for patients with malignant tumors and a combination with endoscopic hemostasis may help improve its safety.

Background: No study compared the techniques and complications of stent removal under fluoroscopy guidance for tracheal fistula and tracheal stenosis.Methods: We conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Eighty-five patients underwent stent removal for tracheal fistula (TF group), and 67 patients for tracheal stenosis (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, survival rate were compared between the two groups.Results: The technical success rate of stent removal was 98.9% and 97.4% for tracheal fistula and tracheal stenosis, respectively. Except for the routine removal for half of patients, excessive granulation tissue was the common indications for stent removal, which was found 142.1±25.9 days later for tracheal fistula, and 89.9±15.0 day for tracheal stenosis. The total incidence of complications was 21.1% and 22.4% for tracheal fistula and tracheal stenosis, respectively. One perioperative death of asphyxia was found in TF group, and 2 deaths in TS group. Recurrence of fistula or stenosis requiring stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3%, 59.6%, and 36.1% for TF group, and 80.4%, 75.7%, 75.7% for TS group.Conclusions: Fluoroscopic removal of tracheal stent is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference. Recurrence of fistula or stenosis requiring stenting was the most comment complication.