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GIE

REVIEW ARTICLEFully covered self-expandable metal stents for treat-ment of benign biliary strictures

Arthur J. Kaffes, MBBS, FRACP, Ken Liu, MBBS, BSci(Med)

Endoscopic therapy has now superseded surgery as first-line therapyfor benign biliary strictures (BBSs). The use of plastic stents, althougheffective in treating BBSs, has been limited by their short stent patencyand the need for repeated endoscopic procedures to achieve strictureresolution. Recently, fully covered self-expandable metallic stents(FCSEMSs) have been increasingly proposed as a new paradigm fortreating BBSs. The effectiveness of FCSEMSs in achieving long-termstricture resolution has been reported in numerous studies. The ver-satility of FCSEMSs has also been demonstrated by their use in bothtransplantation and nontransplantation BBSs and as both first-line andsecond-line therapy settings. Adverse events of FCSEMSs includingpancreatitis, cholangitis, secondary strictures, and pain are usuallyinfrequent and can be successfully managed conservatively. Stentmigration can be problematic for FCSEMSs; however, antimigratorymodifications such as anchor fins and flare ends have shown promise

in preventing this. The use of FCSEMSs for treatment of BBSs is feasible, effective, and safe. Clinical success rates are similar to thoseof plastic stenting with the advantage of fewer procedures.Read this article on pages 13-21 in this issue.

THINKING OUTSIDE THE BOXThe pharynx: examination of an area too often ignored during upper endoscopy

Fabian Emura, MD, PhD, FASGE, Todd Baron, MD, FASGE, Ian M. Gralnek, MD, MSHS, FASGE

Head and neck cancer may be the most costly cancer to treat in the United States. This is particularly noteworthy for health careproviders, their patients, and those paying for health care services because of the high morbidity of such cancers and the fact that only48% of survivors return to work. There are nearly 30,000 incident cases of oral and pharyngeal cancer in the United States annuallywith approximately 8000 deaths as the survival rates have improved little over the past 3 decades. Worldwide, pharyngeal canceraccounts for 130,000 incident cases and 83,000 deaths each year. It is predominantly a cancer in men who use tobacco and consumealcoholic beverages, which are both identified as group 1 carcinogens. Recent articles on the effectiveness of both endoscopicdiagnosis and curative treatment using EMR and endoscopic submucosal dissection (ESD) for early pharyngeal cancer have beenencouraging. Interestingly, GI endoscopists in most of the reported cases have made both the diagnosis and performed the treatmentrather than head and neck surgeons who usually treat such cancer with radical surgery. Although these pharyngeal cancers weredetected during screening esophagogastroduodenoscopy (EGD) examinations, upper endoscopy guidelines do not currently recom-mend examination or photo documentation of the pharynx during EGD. The following review is intended to increase awareness ofpharyngeal cancer within the GI community, emphasize the curability of such cancer when diagnosed at an early stage, and promotethe examination of the pharynx during upper GI endoscopy for high-risk patients.Read this article on pages 143-9 in this issue.

14A GASTROINTESTINAL ENDOSCOPY Volume 78, No. 1 : 2013 www.giejournal.org