The role of metallic expandable stents in treating patients with inoperable esophageal stenosis: The experience of a Greek Cancer Hospital

Abstract

SUMMARY
Aim: The evaluation of efficacy and safety of autoexpandable
metal covered stend endoscopic placement in patients with
malignant esophageal obstructions or stenoses.
Patients and Method: We retrospectively analysed a total
of 61 patients with malignant esophageal obstruction due
to esophageal (n=25), pancreatic (n=1), breast (n=4) and
lung cancer (n=29), primary esophageal melanoma (n=1)
and recurrence of gastric adenocarcinoma after gastrectomy
(n=1). The site of obstruction was in the upper (n=1),
middle (n=34) and lower esophagus (n=23). In 9 cases
gastro-esophageal junction was included. In all patients the
tumour was considered nonresectable. Between 5/1997-6/
2001, 61 Ultraflex covered stents and 4 Flamingo type were
introduced endoscopically. 36 patients required dilation.
Results: Stents were placed successfully in all cases. After
48h all patients were able to tolerate solid or semi-solid
diet. Thirty-seven died 32+6 weeks later, none due to a cause
related to the stent. During the follow-up period, 5 patients
developed dysphagia due to food impaction. One stent 3
weeks after placement, in a case involving gastro-esophageal
junction, migrated to the stomach and a new one was placed.
Eight patients presented recurrent dysphagia. Four of these
with tumour overgrowth at the distal end of the stenosis
were treated with introspective application of Diamed laser (contact fiber) in a total of 13+6 sessions per patient (6782
joules, range 4380-10584 j per session). In the remaining 4
cases, a second stent was placed. No other side effects were
noted.
Conclusion: Placement of self-expanding metal stents is a
safe and effective treatment modality for malignant
esophageal obstruction. In case of expansion of the mass,
laser therapy or placement of a second stent could be used.
Key words: Esophageal malignant obstruction, metal stent,
Diomed laser, palliative treatment