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- W2746526987 abstract "Potential conflict of interest: Nothing to report. TO THE EDITOR: We read with great interest the prospective study by Escorsell et al. demonstrating that self‐expandable, covered, esophageal metal stents (SX‐ELLA Danis; Ella‐CS, Hradec Kralove, Czech Republic) have greater efficacy and fewer serious adverse events in controlling acute esophageal variceal bleeding compared with balloon tamponade.1 However, an important problem of this procedure was not addressed by the investigators: Whereas a recent meta‐analysis published by Shao et al. (which already included the study of Escorsell et al.) described migration after stent deployment in 21.6%,2 Escorsell et al. did not observe a single case of stent migration. In our clinic, we used the SX‐Ella Danis stent several times (n = 3). Although the acute bleeding was stopped successfully, we observed stent migration into the stomach in all cases within 4 days after endoscopic deployment (Fig. 1A,B).Figure 1: Endoscopy showing stent migration into the stomach (A, proximal end; B, distal end of the stent).This seems to be a frequent problem (as indicated by Shao et al. in their meta‐analysis) given that the esophageal diameter in patients with esophageal variceal bleeding tends to be broader than usual, enabling the covered stent to slip downward into the stomach. However, repositioning seems to be risky due to the danger of causing acute variceal bleeding after manipulation. Therefore, we removed the stent immediately upon diagnosing migration. Interestingly, neither Shao et al. nor our group observed a dramatic bleed following stent migration. Possibly, this can be explained by an accelerated obliteration of the esophageal varices, but this, of course, remains hypothetical. To conclude, migration after deployment of covered stents represents a frequent complication in the treatment of esophageal varices. Therefore, clear guidance on what to do—reposition or subsequent removal—needs to be developed." @default.
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- W2746526987 date "2017-04-28" @default.
- W2746526987 modified "2023-10-14" @default.
- W2746526987 title "Comment on “esophageal balloon tamponade vs. esophageal stent in controlling acute refractory variceal bleeding: A multicenter RCT”" @default.
- W2746526987 cites W2341120407 @default.
- W2746526987 doi "https://doi.org/10.1002/hep.29046" @default.
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