Usefulness of self-expandable metal stent for malignant esophageal stricuture

Choi, Cheul Woong; Lee, Joo Ho; Lee, Sang Yong; An, Jin Kwang; Kim, Gwang Ha; Heo, Jeong; Kang, Dae Hwan; Song, Geun Am; Cho, Mong; Yang, Ung Suk

Abstract

BACKGROUND: Most patients with malignant esophageal stricture are surgically incurable at the time of presentation. The aim of this study was to determine the safety and efficacy of endoscopic expandable metal stent for palliation of dysphagia caused by malignant stricture.
METHODS
From January 2000 to December 2001, thirty-two expandable metal stents (Nitis(R) Taewoong Med. Co. Korea, 6 uncovered, 12 covered, 14 double stents for antimigration, 18 mm diameter) were placed in 28 consecutive patients with dysphagia caused by malignancy. Dysphagia score, complications, reintervention, survival length after stent placement were evaluated.
RESULTS
This study consisted of 23 men and 5 women. The patients were composed of 13 esophageal carcinomas, 11 gastro-esophageal junction cancers or cardiac cancers, 3 lung cancers, 1 breast cancer. Immediate improvement of dysphagia symptom was seen after initial stent placement in 27 patients (96%). Dysphagia score decreased from 3.0 (+/-0.51) to 1.06 (+/-0.77) after stent placement. There was one death due to hemorrhage after the procedure. There was no stent migration. Restenting was required in 4 cases due to tumor ingrowth (1/4) and overgrowth (3/4) and average interval to restenting was 95 days. Mean survival length was 109 days.
CONCLUSION
Expandable metal stents offer excellent rapid palliation of malignant dysphagia. In a small subset of patients who received chemoradiation before stent placement, major complications such as bleeding, perforation, were observed.