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DOI: 10.1055/s-2006-944662
The use of self-expanding metal stents to treat acute esophageal variceal bleeding
Publication History
Submitted 26 February 2006
Accepted after revision 9 June 2006
Publication Date:
18 September 2006 (online)

Background and study aims: Acute variceal bleeding is a life-threatening complication of liver cirrhosis. Essential
factors for survival after variceal bleeding are the rapidity and efficacy of initial
primary hemostasis. Endoscopic and vasoactive therapy is the gold standard in the
management of acute variceal hemorrhage. The primary aim of this study was to evaluate
the use of self-expandable metallic stents to arrest uncontrollable acute variceal
bleeding.
Patients and methods: Between November 2002 and May 2005, esophageal stents were implanted in 20 patients
(18 men, two women; mean age 52, range 27 - 87) with massive ongoing bleeding from
esophageal varices, as an alternative treatment to balloon tamponade. The patients
had not been successfully managed with prior pharmacologic or endoscopic therapy.
They had had one to five previous bleeding episodes (mean 2.4). Eight of the patients
were in Child-Pugh grade B and 12 in grade C. A new type of stent with special introducers
was developed that allowed placement without radiographic assistance.
Results: The stents were successfully placed in all of the patients and were left in place
for 2 - 14 days. Bleeding from the esophageal varices ceased immediately after implantation
of the stent in all cases. While the stent was in place, further diagnostic steps
were carried out to optimize management of the patients’ illness and portal hypertension.
No recurrent bleeding, morbidity, or mortality occurred during treatment with the
esophageal stent. All of the stents were extracted without any complications after
definitive treatment had been started.
Conclusions: In this pilot study, the new method of implantation of an esophageal stent was found
to be a safe and effective treatment for massive bleeding from esophageal varices
in patients with liver cirrhosis. These initial clinical results will of course have
to be confirmed in comparative studies including a large number of patients.
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R. Hubmann, M. D.
2nd Dept. of Internal Medicine
Allgemeines Krankenhaus der Stadt Linz · Krankenhausstraße 9 · 4020 Linz · Austria
Fax: +43-732-7806-747228
Email: rainer.hubmann@akh.linz.at