Andreas Adam

Metallic biliary endoprostheses

In patients with obstructive jaundice caused by unresectable malignant tumors, biliary endoprostheses insterted percutaneously or endoscopically can provide excellent palliation. Conventional plastic stents are associated with a relatively high rate of occlusion caused by biliary sludge. Migration is another significant problem. Self expandable, metallic stents can be inserted percutaneously via a small transhepatic track but expand to achieve a relatively large internal diameter. This minimizes the problem of occlusion due to encrusted bile and reduces the rate of reintervention. Migration rarely occurs. Metallic stents have also been employed in the management of recurrent benign biliary strictures unsuitable for surgery. In those patients in whom the frequency of radiological intervention is unacceptably high, such endoprostheses can provide a means of preventing restenosis.

Self-expanding metallic stents in the management of pyloric dysfunction after gastric pull-up operations.

Abstract. The purpose of this paper is to report the use and benefits of self-expanding metallic stents employed in pyloric dysfunction. Four patients treated with oesophagectomy and gastric pull-up for oesophageal carcinoma failed to respond to balloon dilatation for pyloric dysfunction. Three of the patients were thought to have residual tumour at sites remote from the pylorus prior to stenting, but the fourth, who had undergone surgery 8 years previously, was thought to be cured. All were treated with self-expanding metallic stents. All four patients responded well with resolution of their symptoms. Over a mean follow-up of 6 months there has been no recurrence of symptoms. Stent insertion represents a potentially valuable method of treatment in patients with post-surgical pyloric dysfunction in whom simple balloon dilatation has failed.

Treatment of a malignant esophageal perforation with a prototype conical wallstent

A 60-year-old man with a malignant esophageal perforation could not be treated by conventional covered metallic stents because the upper esophagus was dilated. The perforation was eventually closed by deployment of a prototype, conical covered Wallstent.

Covered tracheal stent in the palliation of malignant tracheo-oesophageal fistula

SummaryWe report a case in which a covered tracheal stent was used as the sole palliative treatment for tracheo-oesophageal fistula secondary to oesophageal carcinoma. Previously we have followed this course of action only when use of a covered oesophageal stent has failed. This procedure allowed palliation of a high tracheo-oesophageal fistula that otherwise would have been extremely difficult to manage.

True single-stage percutaneous insertion of Wallstent biliary endoprostheses

SummaryIt is standard practice to leave a temporary external catheter in place for 24–48 h after biliary Wallstent placement. We aimed to establish the safety and effectiveness of a true single-stage procedure. Twenty-two patients underwent Wallstent insertion for palliation of malignant obstruction of the biliary tract. Following percutaneous cholangiography and balloon dilatation of the stricture, 10 mm Wallstent endoprostheses were inserted extending from the upper common hepatic duct to the duodenum. The introducer was then exchanged for a catheter and a cholangiogram performed. In 11 cases the catheter was removed, in the remaining cases it was not removed until after a satisfactory cholangiogram at 24–48 h. All of the patients from whom the catheter was removed made a good recovery with no procedure-related complications; in particular no early stent obstruction or leakage of bile was observed. Right flank pain was minimized and mobilization accelerated by the absence of an external catheter. We fee...

Percutaneous insertion of tunnelled central venous catheters is a safe out-patient procedure

The study was performed to evaluate prospectively the efficacy and safety of insertion of tunnelled central venous catheters as an out-patient procedure in the radiology department. Tunnelled central venous catheters were inserted via the jugular or subclavian veins in 94 patients. The insertion was guided by ultrasound or venography. A post-procedure chest radiograph was obtained and, if the patients were well, they were discharged from hospital after 2h. Insertion was successfully achieved in all patients. Early complications occurred in 19 patients (20.2%) but these were generally minor. A chest drain was inserted into one patient who had a pneumothorax on the post-procedure chest radiograph. All other patients were fit to go home. Late complications occurred in 32 patients (34%), resulting in death in one patient. This study suggests that, with appropriate precautions, out-patient percutaneous image-guided insertion of tunnelled central venous catheters is a safe procedure.

Radiological closure of an enteric fistula with n-butyl-2-cyano-acrylate - case report

SummaryRadiological closure of a fistula from a colo-jejunal anastomosis to the skin was successfully performed in a patient with a colonic interposition after failure of conservative treatment. The method of fluoroscopically-guided injection of cyanoacrylate glue is described. The advantages and disadvantages of cyanoacrylate as a tissue sealant are discussed.