EURORAD ESR

Case 2167

Self-expanding metal stent with anti-reflux valve for palliation of distal oesophageal carcinoma

Author(s)
Laasch H-U, Salahudeen HM, Lee F, England RE, Martin DF
 
Patient
male, 74 year(s)
 
 
  • Figure 1
    Barium swallow

    There is a shouldered, ulcerated stricture of the lower oesophagus. A small hiatus hernia was present below.

     
    Area of Interest: unknown; Imaging Technique: Barium swallow;
     
     
  • Figure 2
    Endoscopic view of the lower oesophagus

    A stenosing tumour is seen. Biopsy showed adenocarcinoma.

     
    Area of Interest: unknown; Imaging Technique: Endoscopic view of the lower oesophagus;
     
     
  • Figure 3
    Staging CT
     

    Section below the aortic arch. Adenopathy is present anterior and to the left of the trachea. The oesophagus is normal.

     
    Area of Interest: unknown; Imaging Technique: Staging CT;

    Section through the carina. The oesophagus is dilated, but otherwise normal.

     
    Area of Interest: unknown; Imaging Technique: Staging CT;

    Section through the left atrium. The is marked circumferential thickening of the oesophageal wall. The lumen is occluded and there is indentation of the posterior wall of the left atrium. The aorta is not involved.

     
    Area of Interest: unknown; Imaging Technique: Staging CT;

    Section through the dome of the right diaphragm showing normal appearance of an axial hernia.

     
    Area of Interest: unknown; Imaging Technique: Staging CT;
     
     
  • Figure 4
    Fer-X Ella anti-reflux stent

    15cm covered stainless steel Ella stent. The large throat reduces the risk of migration. An anti-reflux valve of a "windsock" type is seen at the distal end (arrowheads). The stent is removable by traction on the...

     
    Area of Interest: unknown; Imaging Technique: Fer-X Ella anti-reflux stent;
     
     
  • Figure 5
    Stent insertion
     

    Contrast injection through a per-oral catheter shows a tight stricture of the lower oesophagus. The metal marker indicates the upper margin for easier stent positioning.

     
    Area of Interest: unknown; Imaging Technique: Stent insertion;

    The stricture has been passed with an angled catheter and injection demonstrates an axial hiatus hernia.

     
    Area of Interest: unknown; Imaging Technique: Stent insertion;

    The stent delivery system is advanced over a stiff guidewire.

     
    Area of Interest: unknown; Imaging Technique: Stent insertion;

    Deployed stent with initial expansion limited by the stricture. Note the introducer tip in the stomach (arrow).

     
    Area of Interest: unknown; Imaging Technique: Stent insertion;
     
     
  • Figure 6
    Impaction of introducer tip

    Due to the limited stent expansion the tip would not pass through the waist of the stent.

     
    Area of Interest: unknown; Imaging Technique: Impaction of introducer tip;
     
     
  • Figure 7
    Balloon dilatation
     

    A 15mm/4cm angioplasty balloon has been passed over a second wire and is seen fully inflated.

     
    Area of Interest: unknown; Imaging Technique: Balloon dilatation;

    Stent after removal of delivery system, the guidewire is still in situ. The large anti-migration segment sits just above the stricture.

     
    Area of Interest: unknown; Imaging Technique: Balloon dilatation;
     
     
  • Figure 8
    Check swallow (Iohexol)

    After 24 hours the stent has expanded to its full diameter. Contrast outlines the anti-reflux valve (arrowheads).

     
    Area of Interest: unknown; Imaging Technique: Check swallow (Iohexol);
     
     
There is a shouldered, ulcerated stricture of the lower oesophagus. A small hiatus hernia was present below.
 
A stenosing tumour is seen. Biopsy showed adenocarcinoma.
 
Section below the aortic arch. Adenopathy is present anterior and to the left of the trachea. The oesophagus is normal.
 
Section through the carina. The oesophagus is dilated, but otherwise normal.
 
Section through the left atrium. The is marked circumferential thickening of the oesophageal wall. The lumen is occluded and there is indentation of the posterior wall of the left atrium. The aorta is not involved.
 
Section through the dome of the right diaphragm showing normal appearance of an axial hernia.
 
15cm covered stainless steel Ella stent. The large throat reduces the risk of migration. An anti-reflux valve of a "windsock" type is seen at the distal end (arrowheads). The stent is removable by traction on the retrieval string on the inlet funnel (arrow), which constricts the proximal end.
 
Contrast injection through a per-oral catheter shows a tight stricture of the lower oesophagus. The metal marker indicates the upper margin for easier stent positioning.
 
The stricture has been passed with an angled catheter and injection demonstrates an axial hiatus hernia.
 
The stent delivery system is advanced over a stiff guidewire.
 
Deployed stent with initial expansion limited by the stricture. Note the introducer tip in the stomach (arrow).
 
Due to the limited stent expansion the tip would not pass through the waist of the stent.
 
A 15mm/4cm angioplasty balloon has been passed over a second wire and is seen fully inflated.
 
Stent after removal of delivery system, the guidewire is still in situ. The large anti-migration segment sits just above the stricture.
 
After 24 hours the stent has expanded to its full diameter. Contrast outlines the anti-reflux valve (arrowheads).
 
 
 
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