nitinol and Rectal-Neoplasms

A needle made of nitinol has been developed with enhanced flexibility to overcome the limitations of the currently available 19-G EUS-FNA needles.. Evaluate the ability to perform transduodenal FNAs, procure histologic specimens, and undertake therapeutic interventions using the flexible 19-G needle.. Prospective cohort study.. Tertiary-care academic medical center.. Consecutive patients with subepithelial masses, pancreatic head or uncinate lesions, or lesions adjacent to the pancreatic head, and patients undergoing therapeutic intervention.. Perform tissue acquisition and interventions with the flexible 19-G FNA needle.. Evaluate the ability to perform transduodenal passes with the flexible 19-G FNA needle. Also, assess the utility of the needle to yield both cytologic and histologic samples and to perform therapeutic interventions.. Of the 50 patients enrolled, tissue acquisition was undertaken in 38 and therapeutic intervention in 12. Of 38 patients from whom tissue was procured, 32 tissue samples were from pancreatic head/uncinate or peripancreatic masses and 6 were from subepithelial masses. Tissue acquisition, which included transduodenal passes, was successful and adequate for cytologic assessment in all 38 patients (100%). Satisfactory histologic specimens were procured from 36 of 38 (94.7%) patients. An onsite diagnosis was established in 35 of 38 (92.1%) patients. In 3 patients with indeterminate/suspicious lesions, a definitive diagnosis was established at histology. A mean of 1.45 ± 0.79 passes per patient was performed. All 12 therapeutic interventions were successful (100%) and included pseudocyst drainage in 5, pelvic abscess drainage in 2, fiducial placement in 2, celiac plexus neurolysis in 2, and cholangiogram in 1. Needle dysfunction or procedural complications were not encountered.. Single-center study with limited power.. Preliminary data suggest that the flexible 19-G needle can be used for procuring cytologic aspirates and histologic specimens and to undertake therapeutic interventions even by the transduodenal route. Confirmatory studies are required in a larger cohort of patients with varied pathologic conditions to validate these findings.

Topics: Adult; Aged; Alloys; Cohort Studies; Drainage; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Fiducial Markers; Humans; Male; Middle Aged; Needles; Nerve Block; Outcome Assessment, Health Care; Pancreas; Pancreatic Neoplasms; Pancreatitis, Chronic; Pliability; Prospective Studies; Rectal Neoplasms; Stomach Neoplasms

Currently applied endoscopic palliative treatment of advanced rectosigmoidal carcinoma is hampered by the cost of the equipment, the need for repeated, often painful treatment sessions, and the occurrence of complications. Metallic expandable stents are effective in the palliation of malignant esophageal and biliary stenoses. We evaluated the use of a new type of self-expandable nitinol stent in the palliation of rectosigmoidal carcinoma.. In 10 patients with advanced obstructing rectosigmoidal carcinoma, initial Nd:YAG laser treatment was performed if necessary to allow passage of a gastroscope. Subsequently, a self-expanding nitinol stent with flanged ends was inserted under combined fluoroscopic and endoscopic control. Endoscopic and clinical follow-up was carried out at regular intervals.. After 2+/-0.4 sessions of initial laser therapy, minimal lumen diameter was 9+/-1 mm. Stent insertion was successful in 9 patients, increasing minimal lumen diameter to 14+/-1.2 mm (p < 0.005). In one patient, stent deployment was complicated by a sigmoid perforation, requiring surgery. After insertion, colorectal stents remained adequately positioned and free of obstruction for 103+/-31 days. Patient survival after stent placement was 204 +/-43 days. Stent migration occurred in 3 patients, after 38+/-10 days. Obstruction of the stent because of tumor ingrowth was observed in only one patient, after 268 days.. Insertion of self-expandable nitinol stents in patients with rectosigmoidal carcinoma is technically feasible. Metallic stents are effective in the palliation of malignant rectosigmoid obstruction; they provide an alternative to repeated palliative laser therapy or palliative surgery.

Topics: Aged; Aged, 80 and over; Alloys; Endoscopes, Gastrointestinal; Endoscopy, Gastrointestinal; Equipment Design; Female; Follow-Up Studies; Humans; Intestinal Obstruction; Male; Palliative Care; Radiography; Rectal Neoplasms; Sigmoid Neoplasms; Stents; Survival Rate; Treatment Outcome

Topics: Aged; Alloys; Constriction, Pathologic; Dilatation; Esophageal Neoplasms; Esophageal Stenosis; Humans; Intestinal Obstruction; Male; Rectal Diseases; Rectal Neoplasms