摘要：Surgical esophagectomy, intensive endoscopic surveillan- ce,and mucosal ablative techniques, particularly photodynamic therapy (PDT), h ave been proposed as possible management strategies for Barrett’s high-grade d ysplasia (HGD). Each option has advantages and disadvantages, and no firm consen sus exists for the preferred strategy at this time. The purpose of this pilot st udy was to gain insight into patient preferences in Barrett’s HGD management. T wenty patients with Barrett’s esophagus were enrolled in a questionnaire study. The three possible management options for Barrett’s HGD including each option ’s potential benefits and harms were presented to the subject in a formalized p resentation that was designed to be easily comprehendible by patients. The subje cts rated each strategy using a health-related quality of life instrument and c hose one of the management strategies assuming they were found to have HGD. The average feeling thermometer rating scale values for the management strategies we re as follows: endoscopic surveillance,79; esophagectomy, 46; and PDT, 60. When asked to choose a strategy, 14 (70%) chose endoscopic surveillance,3 (15%) cho se esophagectomy, and 3 (15%) chose PDT. These findings were statistically sign ificant (P = 0.0024). The patients who chose endoscopic su- rveillance felt “comfortable" with endoscopy,while the most common concern ab out esophagectomy,and PDT was the risk of death and the unknown risk of recurren ce, respectively. In summary, when patients with Barrett’s esophagus were prese nted with three options to manage HGD, the majority chose endoscopic surveillanc e. Familiarity with endoscopic surveillance was the predominant reason for the c hoice.

摘要：Abstract Abstract Background: Despite several attempts to make the conventional tubular stents with a central lumen for flow less susceptible to a biofilm buildup and thereby prevent clogging, this goal has remained elusive. We hypothesized that the creation of pathways for fluid flow around the stent instead of through it would avoid this problem. The aim of our study was to report the development and the evaluation of a novel lumen-less stent. Methods: By using a software computer modeling, a 10F “ winged" stent was designed. A pilot feasibility study was performed by using a prototype of this stent for endoscopic biliary drainage in 5 patients with malignant biliary obstruction. Observations: Modeling data revealed that the winged stent offers a larger surface area for flow, higher velocity of flow, and increased flow rates compared with the conventional tubular stent. In the clinical trial, there was a significant decrease of serum bilirubin after the placement of this stent (serum bilirubin before and 2 weeks after stent placement, 14.94 ± 5.7 mg/dL vs. 2.86 ± 1.4 p < 0.004 ), accompanied by radiologic evidence of decompression of the biliary system. Conclusions: We have shown that it is possible to provide adequate biliary drainage by using a stent without a lumen. Such a design may have potential clinical advantages over existing designs.