Self-expanding metal stents (SEMS) are now being increasingly used in palliation of malignant esophageal obstruction and tracheo-esophageal fistula (TEF). The aim of this study was to review our experience with the new generation of SEMS in management of patients who had failed other treatment modalities of palliation. Patients & Methods: Between 8/94 and 8/96 14 patients (12 male; age 68 range 47-81) were referred for palliation of dysphagia (13) and/or TEF (3) after other modalities (surgery, chemotherapy, radiotherapy) of palliation had failed. A total of 17 SEMS were deployed: 3 Ultraflex (Microvasive), 3 Wallstent (Schneider), 5 EsophagoCoil (Instent), 6 EZS (Wilson-Cook). Pre-insertion dilatations were performed (diameter:44±5F) to allow adequate stent expansion after deployment. Palliation was assessed by dysphagia score (0: normal, to 4: inability to swallow saliva) and alleviation of TEF symptoms; then corroborated by esophagogram done within 24 hrs in all patients. Results: SEMS were successfully placed in all patients. In 12/14 patients the dysphagia was immediately relieved as documented by esophagogram and a significant decrease in dysphagia score from 3.5±0.2SE to 1.4±0.2 (p<0.001). In one patient (proximal esophageal stricture with laser-induced TEF) dysphagia could not be relieved as the proximal extent of the stricture was near the UES. However, the stent successfully bridged the TEF. In another patient post-deployment dysphagia relief was not seen as the stent had migrated proximally. Successful palliation of TEF was immediately achieved in all patients using covered stents. Three patients returned within a mean of 31 days (range:1-38) with recurrent symptoms secondary to stent migration (1), overgrowth (1) and TEF (1). In these patients additional SEMS were placed and symptoms successfully palliated. Continued intractable chest pain in one patient necessitated removal of the EsophagoCoil stent. Two patients (gastroesophageal junction cancer with trans-GEJ stent placement) required continued therapy with a proton-pump inhibitor to alleviate reflux symptoms. Conclusion: SEMS provide safe, immediate and effective palliation of malignant esophageal obstruction and TEF in the majority of patients.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging