The role of a novel self-expanding metal stent in variceal bleeding: a multicenter Australian and New Zealand experience

Saad Khan; Rajit Gilhotra; Caroline Di Jiang; David Rowbotham; Andre Chong; Avik Majumdar; Campbell White; Alex Huelsen; Jim Brooker; James O'Beirne; Cameron Schauer; Marios Efthymiou; Rhys Vaughan; Sujievvan Chandran

doi:10.1055/a-1729-0104

The role of a novel self-expanding metal stent in variceal bleeding: a multicenter Australian and New Zealand experience

Endosc Int Open. 2022 Mar 14;10(3):E238-E245. doi: 10.1055/a-1729-0104. eCollection 2022 Mar.

Authors

Saad Khan^{1

2}, Rajit Gilhotra², Caroline Di Jiang³, David Rowbotham⁴, Andre Chong⁵, Avik Majumdar⁵, Campbell White⁶, Alex Huelsen⁷, Jim Brooker⁸, James O'Beirne⁹, Cameron Schauer¹⁰, Marios Efthymiou¹, Rhys Vaughan¹, Sujievvan Chandran¹

Affiliations

¹ Department of Gastroenterology and Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.
² Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
³ Department of Gastroenterology and Hepatology, Auckland District Health Board, Auckland, New Zealand.
⁴ Department of Gastroenterology, Fiona Stanley Hospital, Perth, Western Australia.
⁵ AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁶ Department of Gastroenterology, Taranaki Base Hospital, Taranaki District Health Board, New Zealand.
⁷ Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁸ Department of Gastroenterology, Waikato District Health Board, Hamilton, New Zealand.
⁹ Department of Gastroenterology and Hepatology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.
¹⁰ Department of Gastroenterology, Middlemore Hospital, Counties Manukau District Health Board, Auckland Hospital, New Zealand.

Abstract

Background and study aims Refractory variceal bleeding is associated with high mortality in patients with chronic liver disease. A fully-covered self-expanding metal stent (SEMS) has been reported to have excellent rates of technical success and initial bleeding control; however, studies to date are small and limited to Europe and Asia. Our aim was to evaluate the efficacy and safety of this SEMS for control of refractory variceal bleeding (VB). Patients and methods A retrospective analysis was undertaken of all patients who received the SX-ELLA Danis SEMS for management of VB at 9 tertiary centers across Australia and New Zealand. A total of 32 SEMS had been deployed in 30 patients (median age 53.3). Results Technical success of SEMS placement was achieved in 100 % of cases, resulting in immediate control of bleeding across 31 of 32 cases (96.9 %). Re-bleeding with SEMS in situ occurred in three of 32 cases (9.4 %). Mean SEMS in-dwelling time was 6.4 days. Delayed SEMS migration occurred in 6.3 % of cases. Interventional radiological therapy for management of varices within 6 weeks was performed in 12 of 30 patients (40 %). Death with SEMS in situ occurred in seven of 30 patients (23.3 %). Seven-day bleeding-related mortality was 16.7 %, 14-day mortality 23.3 %, and 6-week mortality 33.3 %. Three of 30 patients (10 %) received orthotopic liver transplantation following SEMS insertion, including two patients within 6 weeks. Conclusions SX-Danis Ella SEMS is highly effective for immediate control of refractory VB and bridging to definitive therapy because it has excellent technical success rates, appears to be relatively easy to use, and has low rates of serious adverse events.

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