Outcomes after placement of a SX‐ELLA oesophageal stent for refractory variceal bleeding—A national multicentre study

• Published in: Liver international Vol. 39; no. 2; pp. 290 - 298
• Main Authors: Pfisterer, Nikolaus, Riedl, Florian, Pachofszky, Thomas, Gschwantler, Michael, König, Kurt, Schuster, Benjamin, Mandorfer, Mattias, Gessl, Irina, Illiasch, Constanze, Fuchs, Eva‐Maria, Unger, Lukas, Dolak, Werner, Maieron, Andreas, Kramer, Ludwig, Madl, Christian, Trauner, Michael, Reiberger, Thomas, Tacke, Frank
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-02-2019; John Wiley and Sons Inc
• Subjects: Adult; Aged; Austria; Balloon treatment; Bleeding; cirrhosis; Cirrhosis and Liver Failure; Dislocations; Dwell time; Endoscopy, Gastrointestinal; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - mortality; Esophageal and Gastric Varices - therapy; Esophagus; Female; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - therapy; Humans; Implants; Liver Cirrhosis - complications; Male; Middle Aged; Mortality; Mucosa; Necrosis; Patients; Placement; portal hypertension; Portasystemic Shunt, Transjugular Intrahepatic; Retrospective Studies; self‐expandable metal stent; Stents; Stents - adverse effects; Surgical implants; Tamponade; Tips; Treatment Outcome; Ulcers; variceal bleeding; Austria; self-expandable metal stent; portal hypertension; variceal bleeding; cirrhosis
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.13971

Background
Current guidelines favour the use of bleeding stents over balloon tamponade (BT) for refractory variceal bleeding (VB) from oesophageal varices. However, data on the efficacy and safety of self‐expandable metal SX‐ELLA Danis stents (SEMS) are limited.
Methods
Cirrhotic patients receiving SEMS for VB at four tertiary care centres were included in this retrospective multicentre study. Rates of failure‐to‐control bleeding (within 5 days) and bleeding‐related mortality (6 weeks) were assessed.
Results
SEMS controlled VB in 79.4% (27/34) of patients. In the rest of patients, other rescue treatments including endoscopic band ligation (EBL, n = 3), SEMS renewed (n = 2) or Linton (n = 2) were applied; however, VB was only controlled in one patient. Early rebleeding within six weeks occurred in 17.6% (6/34) patients. Median SEMS dwell time was three (IQR:6) days. Overall n = 13/34 (38.2%) patients died with SEMS in situ. After SEMS removal, rebleeding and bleeding‐related death occurred in n = 7 (35%) and n = 5 (14.7%) patients respectively. Only 32.4% (10/34) patients did not experience any rebleeding within six weeks after SEMS removal. Bleeding‐related mortality was 47.1% (n = 16/34) and the median survival after SEMS placement was 2.1 months. Notably, no patient received an early transjugular intrahepatic portosystemic shunt (TIPS). The most common adverse events were stent dislocations (n = 13; 38.2%), while ulcers/necrosis of the oesophageal mucosa was seen in only four (11.8%) patients.
Conclusion
SEMS controlled refractory VB in most patients. However, bleeding‐related mortality remained high. While SEMS dislocations were frequent, ulcers/necrosis of the oesophagus was rare. Further studies should investigate whether the wider use of early TIPS reduces bleeding‐related mortality after SEMS placement.