Silicone - Covered Self - Expandable Metal Stents for the Palliation of Malignant Esophageal Obstruction and Esophagorespiratory Fistulas

Lee, Chang Hyeong; Cho, Jae Hyun; Cho, Chang Min; Kweon, Young Ok; Kim, Sung Kook; Choi, Yong Hwan; Chung, Joon Mo

Abstract

BACKGROUND
Esophageal cancer can induce progressive dysphagia and occasionally develop esophagorespiratory fistulas. Surgically incurable disease is present in over 60% of patients at the time of presentation and in such a means, relief of dysphagia is one of the important treatment modes in the majority of these patients. Implantation of stents is widely used for improvement of dysphagia and sealing of esophagorespiratary fistulas.
METHODS
Silicone-covered self-expandable metal stents were used in 19 consecutive patients with malignant esophageal obstruction (n=14) or esophageal obstruction with esophagorespiratory fistulas (n=5).
RESULTS
The stents were successfully inserted in all patients. Dysphagia improved in 18 of 19 patients (95%). All fistulas were sealed and symptoms due to bronchial aspiration disappeared. Complications occurred during follow-up including chest pain (11 patients), aspiration pneumonia (4 patients), reflux esophagitis (2 patients), stent migration (2 patients), tumor overgrowth (2 patients) and hemorrhage (1 patient). Three of the 4 patients with aspirtion pneumonias and a patient with hemorrhage suffered from dysfunction of upper esophageal sphincter after implantation of stents in upper esophageal carcinoma. But, Tumor ingrowth and perforation did not occur. Two patients died of massive hemorrhage and respiratory failure caused by aspiration pneumonia.
CONCLUSION
These results suggest that implantation of silicone-covered self-expandable metal stents is a rapid and effective procedure for the palliative treatment of malignant esophageal obstruction and esophagorespiratory fistulas.