[en] We report a case of life-threatening esophageal hemorrhage after metal stent implantation successfully treated by arterial embolization. An 85-year-old woman was admitted in shock secondary to massive hematemesis and melena. Recent medical history revealed esophageal cancer treated 8 weeks previously by endoesophageal radiotherapy (40 Gy) and endoscopic placement of a covered Wall-stent prosthesis. Selective arteriography of the fifth posterior right intercostal artery showed massive contrast extravasation in the esophagus. Embolization was performed with 150-250-micron polyvinyl alcohol particles. Follow-up at 5 months was uneventful. Arteriography and embolization are advised when severe hemorrhage occurs after esophageal implantation of metal stents.
Disciplines :
Radiology, nuclear medicine & imaging
Author, co-author :
Kos, Xavier; Université de Liège - ULiège
Trotteur, Geneviève ; Université de Liège - ULiège > Services généraux (Faculté de médecine) > Relations académiques et scientifiques (Médecine)
Dondelinger, Robert ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Language :
English
Title :
Delayed Esophageal Hemorrhage Caused by a Metal Stent: Treatment with Embolization
Ogilvie AL, Dronfield MW, Ferguson R, Atkinson M (1982) Palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy Gut 23:1060-1067
Knyrim K, Wagner HG, Bethge N, Keymling M, Vakil N (1993) A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med 329:1302-1307
Watkinson AF, Mason RC, Adam A (1997) Oesophageal stents. In: Adam A, Dondelinger RF, Mueller PR (eds) Textbook of Metallic Stents. Isis Medical Media, Oxford, pp 87-102
Song HY, Do YS, Han YM, Sung KB, Choi EK, Sohn KY, Kim HR, Kim SH, Min YI (1994) Covered, expandable esophageal metallic stent tubes: Experience in 119 patients. Radiology 193:689-695
Watkinson AF, Ellul J, Entwisle K, Mason RC, Adam A (1995) Esophageal carcinoma: Initial results of palliative treatment with covered self-expanding endoprotheses. Radiology 195:821-827
Reinoud Vermeijden J, Bartelsman JF, Fockens P, Meijer RC, Tytgat GN (1995) Self-expanding metal stents for palliation of esophagocardial malignancies. Gastrointest Endosc 41:58-63
Wu WC, Katon RM, Saxon RR, Barton RE, Uchida BT, Keller FS, Rösch J (1994) Silicone-covered self-expanding metallic stents for the palliation of malignant esophageal obstruction and esophagorespiratory fistulas: Experience in 32 patients and a review of the literature. Gastrointest Endosc 40 22-33
Coia LR, Soffen EM, Schultheiss TE, Martin EE, Hanks GE (1993) Swallowing function in patients with esophageal cancer treated with concurrent radiation and chemotherapy. Cancer 71:281-286
Caspers RJ, Welvaart K, Verkes RJ, Hermans J, Leer JW (1988) The effect of radiotherapy on dysphagia and survival in patients with esophageal cancer. Radiother Oncol 12:15-23
Alderson D, Blazeby JM (1995) Expanding metal stents in the gastrointestinal tract. Br J Surg 82:1441-1443
Winkelbauer FW, Schöfl R, Niederle B, Wildling R, Thurnher S, Lammer J (1996) Palliative treatment of obstructing esophageal cancer with nitinol stents: Value, safety, and long-term results. AJR 166: 79-84
Morgan RA, Denton E, Watkinson AF, Tan BS, Ellul J, Jamieson CC, Mason R, Adam A (1996) Metallic stenting of malignant esophageal strictures. (abstract) Cardiovasc Intervent Radiol 19 [Suppl 2]:69
Grundy A (1994) Clinics in interventional radiology. The Strecker esophageal stent in the management of oesophageal strictures: Technique of insertion and early clinical experience. Clin Radiol 49:421-424
North EA (1996) Secondary stenting to overcome complications of primary stenting for inoperable carcinoma of esophagus. (abstract) Cardiovasc Intervent Radiol 19 [Suppl 2]:69
Acunas B, Rozanes I, Akpinar S, Tunaci A, Tunaci M, Acunas G (1996) Palliation of malignant esophageal strictures with self-expanding nitinol stents: Drawbacks and complications. Radiology 199:648-652
Morgan RA, Denton E, Watkinson AF, Ellul J, Mason R, Adam A (1996) Treatment of esophageal leaks and fistulae with covered metallic stents: Experience in 29 patients. (abstract) Cardiovasc Intervent Radiol 19 [Suppl 2]:70
Cwickiel W, Stridbeck H, Tranberg KG, Staël von Holstein C, Hambraeus G, Lillo-Gil R, Willen R (1993) Malignant esophageal strictures: Treatment with a self-expanding nitinol stent. Radiology 187:661-665
Song HY, Choi KC, Cho BH, Ahn DS, Kim KS (1991) Esophagogastric neoplasms: Palliation with a modified Gianturco stent. Radiology 180:349-354
Song HY, Choi KC, Kwon HC, Yang DH, Cho BH, Lee ST (1992) Esophageal strictures: Treatment with a new design of modified Gianturco stent. Radiology 184:729-734