A Prospective Clinical Trial of the Newly Designed Esophageal Covered Metal Stent for Prevention of Stent Migration

Park, Yong Ju; Kim, Young Seok; Kim, Young Tae; Hong, Su Jin; Moon, Jong Ho; Cho, Young Deok; Cho, Joo Young; Lee, Moon Sung; Shim, Chan Sup

Abstract

BACKGROUND AND AIMS
Palliation of malignant esophageal obstructions consists mainly of symptomatic treatment of dysphagia. For this purpose, variable self expandable esophageal stents have recently been used. Of these stents, membrane covered self expandable metal stents (SEMS) are effective to prevent tumor ingrowth and stent obstruction. But migration is the main problem of covered SEMS. So we made a newly designed covered SEMS for the prevention of stent migration and studied prospectively to define its palliative ability and whether this stent is effective for prevention of migration problems. METHODS: From January to December 1998, 27 patients [23 men, 4 women; mean age 60 years, range 20 to 80] were inserted with newly designed esophageal stents and studied. Data analysis included the location and length of malignant strictures, the length of the inserted esophageal stents, the time for fixation of the stents after insertion, complications related to stent insertion, and the effectiveness of the newly designed stent for prevention of the stent migration. RESULTS: 1) The location of esophageal strictures were 4 in the mid- esophagus (three tracheo-esophageal fistula due to two lung and one esophageal cancer, one esophageal cancer), 7 in the distal esophagus (all esophageal cancer), and 16 in the esophagogastric junction (6 cases of esophageal cancer, 9 with gastric cardiac cancer, and 1 with gastric lymphoma). 2) The mean length of the strictures was 5.2 (3 to 12) cm. 3) The mean length of the stents was 11 (8 to 16) cm. 4) Time for fixation of the stents was 7.2 (5 to 13) days after the stent insertion. 5) Stent placement was successful in all patients without any serious stent-related complications such as esophageal perforation or hemorrhage. During the mean follow-up period of 6 (1 to 12) months, there was no stent migration. CONCLUSIONS: The newly designed covered SEMS was very effective in preventing stent migration without any serious stent-related complications, especially in malignant strictures of the esophagogastric junction, short segment strictures, and T-E fistulas without tumor shoulder.