A self-expanding metal stent for complicated variceal hemorrhage: experience at a single center

Background

Refractory variceal bleeding is associated with a high mortality. Existing salvage techniques such as transjugular intrahepatic portosystemic shunt (TIPS) and balloon tamponade (BT) have important limitations and may not be appropriate for all patients.

Objective

To evaluate the safety and efficacy of a novel removable self-expanding metal stent in the management of refractory variceal bleeding.

Design

Case series.

Setting

Tertiary referral liver center.

Patients

Ten patients with variceal hemorrhage with contraindications to TIPS insertion or BT.

Interventions

Insertion of a self-expanding metal stent (SX-Ella DANIS stent).

Main Outcome Measures

Survival, failure to control bleeding, and complications.

Results

Stent insertion was successful in 9 of 10 patients. Failure to control bleeding was observed in 3 patients (2 with gastric varices), with control of bleeding in the remainder. Overall survival at 42 days was 50%. Six patients survived the acute bleeding episode and had stents removed endoscopically at a median of 9 days after insertion. One patient had a minor ulceration of the esophagus caused by stent insertion.

Conclusions

Insertion of the SX-Ella DANIS stent in patients with refractory variceal bleeding or complications of previous therapy is effective for the control of bleeding. Stent insertion can be achieved in the majority of patients without fluoroscopic control and without major complications. In selected patients, SX-Ella DANIS stent insertion offers an alternative to other methods of salvage such as BT and TIPS and could be considered a substitute for BT after a prospective trial.

Abbreviations: BT, balloon tamponade, SEMS, self-expanding metal stent, TIPS, transjugular intrahepatic portosystemic shunt