[Abstract] Objective To investigate and analyze the efficacy observation of endoesophageal stent placement under X-ray and gastroscopy. Methods Seventy-four patients who required endoesophageal stent placement in recent years were divided into observation group and control group. 37 patients in the observation group were operated under X-ray and 37 patients in the control group were operated under gastroscopy, and then the effect of endoesophageal stent placement in the two groups was compared, and the postoperative bleeding in the two groups was compared. The results were significantly higher in the X-ray operation than in the gastroscopic operation, and the bleeding rate in the observation group was significantly lower than that in the control group. Conclusion Through the above analysis, we can conclude that the success rate of the operation performed under X-ray was significantly higher than that of the operation performed under gastroscopy, and the accuracy rate of stent placement in the observation group was significantly higher than that of the control group, and the X-ray operation for esophageal stent placement is the best surgical method, which is worth promoting and applying in clinical practice.
[Keywords] X-ray operation; gastroscopic operation; esophageal stent placement
Currently, most hospitals in China use esophageal stenting for the treatment of postoperative anastomotic stenosis and esophagotracheal fistula in patients with esophageal cancer. It has also been reported that this method has been effective in the treatment of this disease and is widely used in clinical practice. At present, the clinical implementation of esophageal stenting is generally performed by both X-ray and gastroscopic methods. In recent years, 74 patients who required endoesophageal stent placement were received in our hospital, and the endoesophageal stents were placed by two different methods, and the surgical effect of the X-ray operation was found to be significantly higher than that of the gastroscopic operation after placement.
1. Clinical data and methods
1.1 Clinical data
From July 2008 to November 2009, we received 74 patients who required endoesophageal stenting, of whom 48 were male and 26 were female, with the average age ranging from 48 to 72 years. 74 patients had obvious choking sensation before surgery, and all patients with esophagotracheal fistula were unable to eat. We divided these 74 patients into observation and control groups. 37 patients in the observation group were operated on by X-ray. 28 patients in the observation group had esophageal stricture, 7 patients had anastomotic stricture, and 2 patients had esophagotracheal fistula. In the control group, 37 patients were operated by gastroscopy. In the control group, 27 patients had esophageal strictures, 8 patients had anastomotic strictures, and 2 patients had esophagotracheal fistulas. The patients in the observation and control groups were confirmed by upper gastrointestinal imaging, gastroscopy and surgical pathology.
1.2 Methods
1.2.1 X-ray operation
To perform the subx-ray operation on the patients, the patients were placed in the supine position, and then the super-slip guidewire was passed through the stenotic segment. When feeding the catheter to the distal end of the stenotic segment, it must be fed along the guidewire. After the catheter is successfully fed, the guidewire can be withdrawn, and then the patient can be injected with contrast, which can effectively confirm that the catheter is located in the patient’s stomach, and then the reinforcing guidewire can be fed along the catheter. After successful feeding, the catheter can be withdrawn, and in patients with severe stenosis, balloon catheter dilation can be taken. The device is then delivered to the stenotic segment by guiding it through the guidewire under the supervision of a monitor, after which the stent can be adjusted, and the position must be such that the center point of the stent coincides with the center of the stenotic segment. After successful stent placement, a canonical agent imaging can be performed to understand the placement and opening of the stent.
1.2.2 Gastroscopic manipulation
When performing the gastroscopic operation on the patient, the patient’s supine position is also taken, and then the reinforcing guidewire is passed through the stenotic segment, and the reinforcing guidewire is guided by the gastroscope when passing through the stenotic segment. The distance of the patient’s stenotic segment from the incisors is then measured. In patients with severe stenosis, they may be dilated with a Shah dilator. Then, according to the distance measured by gastroscopy, the device is delivered to the stenotic segment by guidewire guidance, and the stent can be placed afterwards.
1.3 Statistical methods
SPSS15.0 statistical analysis software was used for processing. The count data was tested by X2 with the test, and the difference of P<0.05 was statistically significant.
2. Results (Table 1, Table 2)
2.1 Surgical success rate
Among the 37 patients in the observation group, all the surgeries were successful, while among the 37 patients in the control group, 4 patients could not pass the guidewire due to severe esophageal stenosis, and 3 patients in the control group had their stents displaced during stent placement, which led to the stenosis not being released. The results of the comparison between the two groups were significantly different, with statistical significance P<0.05, as shown in Table 1.
Table 1 Comparison of the stent placement effect between the observation group and the control group
Group
Esophageal stenosis
Esophageal stricture
Anastomotic stenosis
Anastomotic stenosis
Esophagotracheal fistula
Esophagotracheal fistula
Number of cases
Success
Number of cases
Success
Number of cases
Success
Observation group
28
28
7
7
2
2
Control group
27
20
8
8
2
2
2.1 Complications
Among the 37 patients in the observation group, there were 20 patients who used balloon catheter dilation, none of them had bleeding, and 3 patients had recurrence after surgery, all of them had vomiting of blood. Among the 37 patients in the control group, there were 16 patients who used Sha’s dilator, and 13 of them vomited blood, and the vomiting of blood appeared to be improved after stent placement, and 3 patients recurred after surgery, and all of them vomited blood. There was a difference in postoperative bleeding between the two groups, with statistical significance P<0.05, as detailed in Table 2.
Table 2 Comparison of postoperative bleeding between the observation group and the control group
Group
Number of surgical cases
Bleeding cases
Number of postoperative recurrence
Number of postoperative bleeding cases
Observation group
20
0
3
3
Control group
16
13
3
3
3 Discussion
It has been reported that endoesophageal stenting is an excellent method in the treatment of GI strictures and esophagotracheal fistulas, and it is clinically accepted. With the above analysis, we can conclude that the effect of X-ray esophageal stenting is significantly higher than that of gastroscopic esophageal stenting, but it has also been reported that there is no definitive conclusion as to which of the two different methods is better. However, it has also been reported that this method is not better than the simple X-ray operation and the contraction is more tedious. From the above analysis, we can conclude that the success rate of the operation performed under X-ray is significantly higher than that of the operation performed under gastroscopy, and the accuracy of stent placement in the observation group is significantly higher than that of the control group, and the implementation of esophageal stent placement under X-ray is the best surgical method, which is worth promoting and applying in clinical practice.