Clin Endosc.  2012 Sep;45(3):235-239.

Esophageal Stent for Cervical Esophagus and Esophagogastric Junction

• Shim CS

Abstract

Tumors in the cervical portion of the esophagus have traditionally been more difficult to manage. The implantation in the cervical esophagus is a technically demanding procedure. The implantation of modified self-expandable metal stents (SEMSs) was very effective perorally under endoscopic and fluoroscopic guidance. Experience with SEMS has revealed an increased risk of migration when either covered stents are used or a stent is implanted across the gastroesophageal junction. The modified, covered, esophageal stents appear to prevent stent migration and improve dysphagia in patients with malignant tumor stenosis at the esophagogastric junction. Besides heartburn, regurgitation is sometimes very distressing to patients and may lead to fatal aspiration due to reflux after stenting in esophagogastric junction. These symptoms can be reduced by the use of valved stent. The long S-shape valve is very effective in preventing acid reflux and valve inversion.

Keyword

Antimigration stent; Antireflux stent; Cervical esophageal stent

MeSH Terms

Constriction, Pathologic
Deglutition Disorders
Esophagogastric Junction
Esophagus
Heartburn
Humans
Stents

Figure

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  Fig. 1 Self-expandable metal stents for the cervical esophagus. In order to decrease the foreign body sensation, we reduced the length of its proximal funnel to 7 mm, the fully expanded diameter being 18 mm.

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  Fig. 2 (A) The lesion was located 16 cm from the incisors, 1 cm below the upper esophageal sphincter. (B) Post-stenting radiograph, showing well positioned cervical stent.

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  Fig. 3 Shim's technique for antimigration. (A) A 14-Fr rubber tube covering the silk is connected to patient's earlobe until the proximal part of the stent becomes completely fixed to the esophageal mucosa. (B) The uncovered proximal flange will be firmly fixed to the esophageal mucosa, and prevents the stent migration. (C) Endoscopic image just after implantation of antimigration stent.

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  Fig. 4 Niti-S stent with a double-layer configuration, consisting of an inner polyurethane layer and an outer uncovered Nitinol wire.

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  Fig. 5 Esophageal stent with S-type antireflux valve. Modified antireflux stent is a fully covered esophageal stent which has a S-type antireflux valve with long leaflet inside the stent's body and we fixed antireflux valve at stent wall in order to minimize acid reflux and to prevent inversion of the valve.

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  Fig. 6 Various modified skirt type self-expanding metal esophageal antireflux stents.

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