Search Results (101)

Hydronephrosis caused by malignant ureteral obstruction or radiotherapy-induced ureteral stenosis is a frequent complication in patients with cervical cancer. Effective management requires continuous urinary drainage, which can be achieved either internally through ureteral stent placement or externally via percutaneous nephrostomy. Among available devices, the Allium^TM fully covered nitinol mesh ureteral stent is designed to treat ureteral or urethral strictures while allowing safe and easy removal. However, serious complications have been reported, including uretero-enteric, uretero-arterial, and uretero-vaginal fistulas, pseudoaneurysm, ureteral perforation and sepsis. We report the case of a 44-year-old woman diagnosed in 2020 with stage IIIC1 cervical cancer (FIGO classification) who underwent surgery followed by adjuvant radiotherapy. In 2021, a right metallic ureteral stent was placed to treat ureteral obstruction. Two years later, she presented with right lumbar pain, and abdominal ultrasonography revealed grade III right hydronephrosis. CT scan demonstrated migration of the metallic ureteral stent into the rectal wall. Endoscopic extraction of the migrated stent was successfully performed via colonoscopy. Retrograde pyelography and CT imaging confirmed the presence of a recto-ureteral fistula. A 6 Ch/26 cm double-J ureteral stent was subsequently placed with good positioning and drainage. At the six-month follow-up, replacement of the double-J stent was performed. Imaging studies showed only minor residual hydronephrosis. Although metallic ureteral stents are effective for managing malignant ureteral obstruction, particularly in complex oncologic cases, they are not free of severe complications. The risk appears increased in patients who have undergone radiotherapy, emphasizing the need for careful monitoring and long term follow-up. Full article

Background/Objectives: the study aims to evaluate early outcomes of endovascular aneurysm repair (EVAR) using the ultra-low-profile Minos^TM Abdominal Aortic Stent-Graft in elective and emergent infrarenal abdominal aortic aneurysm (AAA), and compare its performance with established EVAR devices. Methods: This retrospective single-centre study included 79 patients treated with the Minos stent-graft between September 2020 and August 2024. Primary endpoints were 30-day mortality and major adverse events (MAEs). Secondary outcomes included technical success, endoleak rates, sac dynamics, reintervention rates, and stent-graft patency. Imaging follow-up was performed on day 1, at 4–6 weeks, at 6–12 months, and annually thereafter. Results: The cohort (mean age 74.6 ± 8.2 years; 83.5% male) included 60 elective and 19 emergent cases, with high cardiovascular comorbidity and challenging anatomy (48.1% with iliac diameters < 7 mm and 16.5% < 5 mm; 20.3% hostile necks). Technical success rate was 93.7% (elective: 95.0%; emergent: 89.5%). Persistent endoleaks occurred in 14.0% of patients (type II 12.7%, type I 1.3%). Clinical success was achieved in 88.6% (elective: 90.0%; emergent: 84.2%). Six-month survival was 96.1% in the elective and 89.5% in the emergent cohort. MAEs were more frequent in emergent cases: acute kidney failure (31.6% vs. 3.3%; p = 0.004) and pneumonia (31.6% vs. 0.0%; p < 0.001). Mean follow-up was 12.5 ± 9.9 months (median 9.3). Reinterventions were required in 16.5% within 30 days, more frequently in emergent cases (31.6% vs. 11.7%, p = 0.041). Sac regression ≥5 mm occurred in 43.0%. No stent-graft migrations or infections were reported. Conclusions: Minos demonstrated reliable performance and safety in elective and emergent EVAR with excellent anatomical applicability due to its ultra-low-profile design. Full article

Recent advancements in biology and medicine have facilitated the progress of nerve regeneration that markedly improves the treatment of peripheral nerve injuries, enhancing outcomes and recovery rates. It has been reported that erythropoietin (EPO) is currently being studied as a potential agent for neural repair. However, much evidence has confirmed that EPO treatment can induce systemic adverse effects in the clinical fields, including coronary stent thrombosis and deep vein thrombosis. Herein, a derivative of EPO without any hematopoietic activities, which is named carbamylated erythropoietin (CEPO), has been synthesized and investigated for its effects on peripheral neural repair both in vitro and in vivo. The in vitro experimental results demonstrated that CEPO enhanced Schwann cell viability, proliferation, migration, and nerve growth factor (NGF) expression, while the optimal concentration of CEPO was found to be 25 μg/mL. The in vivo observations at 21 days post-injection indicated that the CEPO group exhibited a significant functional improvement in the sciatic nerve injury model, guiding regrowing axons across the injury site. Thus, CEPO serves as a promising candidate or adjunctive strategy for peripheral nerve injuries, demonstrating promising clinical applications and potential for enhancing Schwann cell viability, proliferation, and migration, as well as anticipated nerve axon development. Full article

A 14-year-old spayed female Maltese dog presented with hematuria, pollakiuria, decreased urine volume per voiding, and prolonged urination time, and was diagnosed with multifactorial urinary obstruction involving suspected trigonal neoplasia and extensive urolithiasis affecting the kidneys, ureters, bladder, and urethra. Diagnosis was based on serum biochemical analysis, radiography, and ultrasonography, which revealed diffuse urolithiasis, urethral involvement, and a trigonal mass consistent with a suspected neoplastic lesion. Due to the multifocal nature of obstruction, surgical management was considered impractical. The patient underwent urethral stent placement as a minimally invasive palliative intervention. Following the procedure, rapid restoration of urine flow was achieved, and significant improvement in renal parameters, including blood urea nitrogen and creatinine, was observed within 3 days. During follow-up, the stent remained well positioned without migration. Although transient deterioration, including hydronephrosis and increased renal parameters, was noted at day 52, subsequent improvement was observed by day 64, suggesting a dynamic course of obstruction. This case demonstrates that urethral stenting can be an effective treatment option for managing complex, multifactorial lower urinary tract obstruction in dogs, providing rapid clinical improvement and sustained urinary patency. However, progressive changes in the upper urinary tract may occur, emphasizing the importance of comprehensive evaluation and continuous monitoring. Full article

Background/Objectives: Malignant distal biliary obstruction (MDBO) is a frequent complication of pancreatic cancer and often leads to obstructive jaundice, impaired liver function, and delayed oncologic treatment. Endoscopic biliary drainage using endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the standard minimally invasive approach for restoring biliary flow. However, clinical outcomes and complication rates vary across studies depending on stent design, placement technique, and patient characteristics. The aim of this systematic review was to evaluate the clinical outcomes and complications associated with endoscopic biliary stenting in pancreatic cancer-related MDBO. Methods: A systematic literature search was performed in PubMed/MEDLINE, ScienceDirect, Web of Science, and the Cochrane Library for studies published between January 2016 and January 2026. Studies evaluating ERCP-guided biliary stenting in adult patients with pancreatic cancer-related malignant distal biliary obstruction were included. Study selection followed PRISMA 2020 guidelines, and methodological quality was assessed using the Newcastle–Ottawa Scale. Clinical outcomes including technical success, clinical success, stent patency, recurrent biliary obstruction, and procedure-related complications were analyzed. Results: Eighteen studies involving a total of 3291 patients were included in the qualitative synthesis. Technical success rates were consistently high, reaching up to 100% in several studies, while clinical success rates generally exceeded 90%. Median time to recurrent biliary obstruction ranged from approximately 102 to 541 days depending on stent type and placement technique. Recurrent biliary obstruction was the most frequently reported complication, occurring in 30.7% of patients. Stent migration occurred in 14.9% of cases, while post-ERCP pancreatitis was reported in approximately 4.2% of patients. Several studies demonstrated longer patency with self-expandable metal stents compared with plastic stents. Conclusions: Endoscopic biliary stenting performed during ERCP is an effective and safe strategy for the management of malignant distal biliary obstruction in pancreatic cancer. Self-expandable metal stents provide more durable biliary drainage and reduce the need for repeat interventions. Nevertheless, recurrent biliary obstruction remains a common limitation, highlighting the need for further improvements in stent technology and optimized placement strategies. Full article

Background/Objectives: Ureteric stents are commonly used in urological procedures. However, they can cause pain; haematuria; voiding symptoms; or stent migration. When stent migration occurs, this can cause a significant impact on the patients’ therapeutic outcomes and may warrant a repeat procedure to retrieve or replace the ureteric stent. This study aims to assess if there are any patient; stent; or operative factors that may increase the risk of stent migration. Methods: This is a single-institute, retrospective cohort study that looked at patient; stent; and operative factors for 828 ureteroscopies and or laser lithotripsy for management of ureteric or intra-renal calculi over a 2-year period. The 828 procedures comprised 655 patients, as some patients had multiple procedures. Results: From the 828 cases, there was a 2.7% incidence of stent migration; all episodes of stent migration were distal migration. Stent migration was more likely among females (odds ratio (OR) = 3.0; 95% confidence interval (CI) [1.2; 7.1]) compared to males; older aged groups (over 65 years) (OR = 2.7; 95% CI [0.9; 7.8]) compared to the young aged group (16–44 years); and those who were obese (OR = 2.1; 95% CI [0.9; 5.0]), had musculocutaneous (MSK) conditions (OR = 2.7; 95% CI [0.9; 8.3]), neurological conditions (OR = 3.3; 95% CI [1.1; 10.0]), and stent dwelling time ≥ month (OR = 2.3; 95% CI [0.9; 6.0]) compared to <1 month. There was no observed association between stent and operative factors. Conclusions: Patient factors such as sex; age; comorbidities; and weight need to be considered by urologists in conjunction with modifiable stent factors to ensure that the decisions are made on an individual basis to try and reduce the risk of stent migration. Full article

Esophageal stent insertion is a key palliative therapy for malignant esophageal strictures, but the postoperative migration rate remains as high as 40%, significantly compromising clinical outcomes. Stent migration behavior is closely related to its structure and mechanical properties; however, the underlying mechanisms remain unclear, and there is a lack of effective in vitro evaluation methods to predict migration risk. Herein, we first developed a novel biomimetic swallowing peristalsis simulation device that highly replicates human physiological environments and swallowing waveforms—addressing the limitations of existing in vitro testing methods. Using this device, we demonstrated for the first time that stent migration is co-regulated by radial force and axial bending stiffness: higher radial force enhances anchoring via increased friction, while lower bending stiffness (superior flexibility) reduces migration risk by maintaining a larger stent–esophagus contact area and improving energy dissipation during swallowing. These conclusions are supported by our theoretical derivations and test results of stents with different densities. In addition, it was found that food viscosity and tumor block also influence stent migration risk. This study elucidates the synergistic mechanism of esophageal stent migration and provides a theoretical foundation and an in vitro validation platform for the design of a new generation of anti-migration esophageal stents. Full article

Endoscopic biliary drainage using self-expanding metal stents (SEMSs) is a standard palliative therapy for cholangitis and obstructive jaundice caused by malignant distal biliary obstruction (MDBO). Fully-covered SEMSs (FC-SEMSs) prevent tumor ingrowth and provide longer patency; however, recent advances in chemotherapy have increased stent migration due to tumor shrinkage, resulting in reduced functional patency compared with uncovered SEMSs. Partially covered SEMSs can reduce migration but are often difficult to remove after deployment. In addition, adverse events such as acute pancreatitis and cholecystitis remain a concern with FC-SEMSs. To address these limitations, Dr. Kobayashi introduced a novel porous SEMS with multiple side holes in the covering membrane (MH-SEMSs) in 2019. This design allows limited bile duct epithelial ingrowth through side holes, providing anchorage while maintaining removability. The side-hole structure may also reduce cholecystitis and pancreatitis by preserving flow through the pancreatic and cystic duct orifices. Over five years since their introduction, clinical evidence supporting MH-SEMSs has steadily increased. This review summarizes current data and explores future perspectives for MH-SEMS use in MDBO management. Full article

Background and Objectives: Anastomotic leak following total gastrectomy and Roux-en-Y reconstruction remains a challenging and potentially morbid clinical scenario. Systemic support and resuscitation with simultaneous local sepsis control remain pillars of treatment. The therapeutic strategy may vary among different centers depending on the severity of clinical presentation, the degree of contamination and the hospital resources. The aim of this study is to introduce the rendezvous stenting technique, which combines washout of the abdominal cavity and endoscopic stenting under direct vision in selected patients who require reoperation. Materials and Methods: A retrospective descriptive analysis of severely ill patients suffering an anastomotic leak from an esophagojejunal anastomosis, who had been operated on in our department during the last five years was performed. Patient demographics, perioperative data and surgical outcomes were collected. Results: Since 2018, six anastomotic leak patients underwent stenting of anastomotic leak using the rendezvous technique during reoperation. Stenting was effective in controlling local contamination in five out of six patients (83.3%). One patient required repeat stent placement due to improper stent width. Conclusions: Anastomotic stenting using the rendezvous technique is a safe and feasible technique. Combining drainage of the abdominal cavity and stent fixation allows for control of the contaminated field as well as minimizing the risk of stent migration. Full article

Three-dimensional printing has emerged as a promising technology in endovascular surgery for the production of patient-specific stent-grafts. Thermoplastic polyurethane (TPU) is widely used for this purpose due to its favourable biocompatibility, hemocompatibility, and mechanical properties. However, its long-term stability under physiological conditions remains uncertain. This study evaluates the ageing behaviour of 3D-printed TPU stent-grafts under accelerated oxidative conditions (20% H₂O₂–0.1 M CoCl₂) over three months, corresponding to approximately 45 months in vivo, and during three months in hydrolytic (0.1 M NaOH) conditions. Mechanical, physicochemical, thermal, and surface properties were periodically analysed. Differential scanning calorimetry revealed a decrease in crystallisation enthalpy of 41% and a reduction in melting enthalpy of 29% after hydrolytic ageing, whereas no decrease was observed after oxidative ageing. Despite these chemical changes, size exclusion chromatography indicated minimal chain scission. However, spectroscopy and microscopy showed minor chain scission and additive migration (antioxidant and lubricant). Nevertheless, tensile testing highlighted that mechanical performance remained within clinically acceptable ranges. These findings demonstrate that 3D-printed TPU vascular implants retain essential properties under prolonged simulated ageing, supporting their safety and durability for vascular applications. Full article

Background: Anastomotic leakage (AL) is a major complication after esophago-gastric surgery, with incidence rates of 11–21% and mortality up to 14%. Early intervention is essential to reduce morbidity. Endoscopic treatments have advanced, with self-expandable metal stents (SEMSs) as the traditional standard (success ~90%), but they carry risks like migration, stenosis, and need for drainage. Endoscopic vacuum therapy (EVT), applying negative pressure to drain secretions and promote healing, has shown success rates of 66–100%. Limited comparative data exists from small retrospective studies. This study compares SEMS and EVT for safety and efficacy in AL management. Methods: A retrospective case–control study from a prospective database at our institution was performed (March 2012–2025). We included patients with AL post-esophageal/gastric surgery treated endoscopically (SEMS or EVT). We excluded patients treated with conservative or surgical management. Demographics, comorbidities, oncology, surgery type, leak details, treatments, and outcomes were collected. Primary outcome was complete healing of the leak, while secondary outcomes were time to success, number of procedures needed, hospital stay, complications, mortality. Results: From 592 resections, we extracted 68 AL (11.5%), 45 of which met the inclusion criteria (22 SEMS, 23 EVT). Groups were similar demographically, but SEMS had more respiratory issues (43% vs. 8.7%, p = 0.018). SEMS were used more after esophagectomy (86.4% vs. 56.5%, p = 0.004); EVT was performed mostly after gastrectomy (34.7% vs. 9.1%, p = 0.009). Success rate was 86.4% for SEMS vs. 95.6% for EVT (p = 1.000). Complications were significantly lower in EVT (8.3% vs. 50%, p = 0.001; SEMS: 36.4% migrations, 18.2% stenoses). Leak onset time, modality of diagnosis, and leak size were comparable among the groups. Need for jejunostomy was higher in EVT (43.5% vs. 9.1%, p = 0.015), while chest drains in SEMS (63.7% vs. 13.1%, p < 0.001). Hospital stays (33–38 days, p = 0.864) and mortality (22.7% vs. 8.7%, p = 0.225) were similar. No differences were observed in terms of long-term mortality (log-rank p = 0.815). Conclusions: SEMS and EVT are both effective for AL after esophago-gastric surgery. EVT offers fewer complications and shorter treatment, so it is favored especially for esophago-jejunal leaks. Full article

Background: While the side-by-side stenting technique-characterized by the parallel placement of stents offers procedural simplicity, the augmented radial force exerted by the initial stent may complicate subsequent deployment. This multicenter study evaluated the practicality and safety of bilateral side-by-side stenting using novel braided self-expandable metal stents (Benefit^TM; M.I.Tech Co., Ltd., Pyeongtaek, Republic of Korea). Statistical analysis included survival analysis (Kaplan–Meier) and Cox proportional hazards regression to identify predictive factors. Patients and Methods: In this multicenter study, patients with inoperable malignant hilar biliary obstruction (Bismuth type II–IV) underwent simultaneous side-by-side endoscopic placement of two braided self-expandable metal stents. The primary outcome was stent patency. The secondary outcomes included technical and clinical success, and adverse events monitored for up to one year. Results: A total of 27 patients were included in the final analysis. The technical success rate was 92.6% (25/27), and the clinical success rate was 88.0% (22/25). The median stent patency was 93 days, with cumulative patency rates of 87.4% at 3 months and 49.7% at 12 months. Tumor ingrowth was the most common cause of stent occlusion (66.7%). Early adverse events occurred in 2 patients (one cholangitis and one stent migration), supporting the favorable safety profile of this approach. Conclusions: The simultaneous side-by-side placement of novel braided self-expandable metal stents yielded high technical success and favorable clinical outcomes in patients with inoperable malignant hilar biliary obstruction. This approach provided substantial stent patency with a low complication rate, supporting its utility as a safe and effective palliative strategy for the management of malignant hilar biliary obstruction. Full article

Endoscopic ultrasound (EUS)-guided drainage using lumen-apposing metal stents (LAMSs) has become the standard for managing pancreatic fluid collections (PFCs), especially walled-off necrosis (WON). However, LAMS-specific adverse events (AEs), including bleeding, stent occlusion, and infection, remain a concern. To mitigate these complications, some experts advocate placing coaxial double-pigtail plastic stents (DPPSs) within LAMSs. This narrative review critically examines the evidence from retrospective and prospective studies, one RCT, and recent meta-analyses on this combined approach. While the routine use of coaxial double-pigtail plastic stents (DPPSs) within LAMSs is not universally supported, emerging data suggest benefits in select high-risk scenarios, such as large WON, debris-rich cavities, or disconnected pancreatic duct syndrome (DPDS), in which coaxial DPPS within LAMSs can reduce occlusion, infection, and recurrence. In addition, the type of LAMS appears to influence safety outcomes: the SPAXUS stent shows lower bleeding and migration rates than the Hot AXIOS. We propose a pragmatic algorithm for the patient-tailored use of coaxial DPPS and discuss technical innovations to improve outcomes. While evidence is still evolving, personalized strategies and future high-quality studies are needed to define the optimal role of coaxial DPPS within LAMSs in the EUS-guided drainage of PFCs. Full article

Background: Long-term follow-up after endovascular aortic repair (TEVAR) is crucial to detect adverse aortic remodeling, even with modern stent grafts offering enhanced flexibility and durability. Conventional imaging, based on diameter measurements, may fail to identify complications such as endograft migration. Methods: We conducted a longitudinal 3D geometric analysis of thoracic aortic and stent-graft evolution over 10 years in a patient treated for descending thoracic aortic aneurysm (DTAA) by endovascular treatment. A three-dimensional morphological analysis (length, tortuosity, angulation, and diameter) was carried out using advanced imaging software (EndoSize, MATLAB) to track aortic geometry and stent-graft behavior over time. A focused review of the literature on stent-graft migration, its risk factors, complications, and surveillance strategies was also performed. Results: This case illustrates how progressive geometric remodeling—including aortic elongation and increased tortuosity—can lead to delayed stent-graft migration and late type III endoleaks, with an elevated risk of rupture. The 3D analysis revealed early morphological changes that were undetectable using standard diameter-based follow-up. These observations are consistent with published data showing higher migration rates over time, particularly in tortuous anatomies. The literature review further emphasizes the clinical relevance of geometric surveillance, given the high rates of reintervention, morbidity, and mortality associated with stent-graft migration. Conclusions: This study underlines the importance of personalized and geometry-based surveillance after TEVAR. Advanced morphological assessment tools provide valuable insights for the early detection of complications and tailored patient management. Their integration into routine follow-up could help optimize long-term outcomes and prevent life-threatening events such as rupture. Full article

Endotracheal prosthesis placement is employed as a therapeutic intervention for tracheal lesions in cases where conventional surgical approaches are not feasible. The learning curve for endotracheal stent placement can vary depending on the type of stent, the training environment, and the clinician’s prior experience; however, it is generally considered moderately complex. Inadequate practice can have serious consequences, as the procedure involves a critical area such as the airway. The main risks and complications associated with inadequate technique or improper execution can include stent migration, formation of granulation tissue or hyperplasia, tracheal or pulmonary infection, obstruction or fracture of the stent, hemorrhage and tracheal perforation, among others. The purpose of the present study is to summarize important information and evaluate the role of different material features in the 3D printing manufacturing of an appropriate tracheobronchial medical device, which should be as appropriate as possible to facilitate placement during surgical practice. A complex stent design was fabricated using three different biodegradable materials, polycaprolactone (PCL), polydioxanone (PDO), and polymer blend of polylactic acid/polycaprolactone (PLA/PCL), through additive manufacturing, specifically fused filament fabrication (FFF)3D printing. Parameter optimization of the 3D printing process was required for each material to achieve an adequate geometric quality of the stent. Experimental analyses were conducted to characterize the mechanical properties of the printed stents. Flexural strength and radial compression resistance were evaluated, with particular emphasis on radial force due to its clinical relevance in preventing collapse after implantation in the trachea. The results provide valuable insights into how material selection could influence device behavior during placement to support surgical requirements. Full article