Use of SEMS for palliation of malignant esophageal obstruction and TE fistula is now well accepted. We evaluated the efficacy of using SEMS in patients with previously placed SEMS presenting with recurrence of symptoms. Patients & Methods: 14 patients (12m, 2f, age: 68 yrs, range 47-81) were treated with SEMS for palliation of malignant dysphagia (13) and TE fistula (3). Three of 14 patients presented with recurrence of symptoms and were treated by placing another SEMS. One patient (obstructing esophageal cancer) presented 25 days after placement of a covered Ultraflex, 1315 (Microvasive, Boston) SEMS with symptoms of coughing during swallowing. On a swallow study, barium was seen passing between the stent and the esophageal wall into a TE fistula. On endoscopy, the upper runnel of the stent was seen to have longitudinally buckled by tumor growth creating a gap between the funnel and the esophagus. The distal funnel of an EZS-25-12 (Wilson-Cook, Winston-Salem) stent was cut, and the remaining stent was successfully deployed into the Ultraflex stent with the 25mm diameter upper funnel of the EZS stent sealing the gap between the stent and the esophageal wall. The second patient (esophagus cancer with TE fistula) had recurrence of dysphagia for semisolids within 24 hours after placing an EZS-21-8 stent. Endoscopy revealed the stent to have migrated 2cms proximally with tumor obstructing the lower end of the stent. Attempts to remove the stent were unsuccessful. With the proximal funnel cut, an EZS-21-6 stent was deployed into the first stent bridging the tumor below. The third patient (esophageal compression secondary to lung cancer) had an EsophaCoil EG-16-10 (Instent, Eden Praire) placed for dysphagia palliation 38 days prior to presenting with recurrent dysphagia for liquids. Endoscopy (N30, Olympus endoscope, 5.3mm outside diameter) revealed polypoidal granulation tissue (biopsy proven) projecting into and around only the upper and lower ends of the stent. Attempts to remove the stent were unsuccessful. An EZ-25-12 stent was cut in the middle and one piece (funnel-end down) was first placed into the distal end of the EsophgaCoil and then the other piece at the proximal end (funnel-end up). Results: Barium swallow done 12 hrs later in all cases showed free flow into the stomach without leakage and the patients could swallow semisolids until their death (68±15 days). All cases complained of chest pain that regressed within a week. One case (TE fistula), developed fever on the day of the procedure that responded to antibiotics. The last case had minor bleeding during the unsuccessful attempt at removing the first stent. Conclusions: Use of SEMS in patients with previously placed esophageal stents is safe and feasible and is an effective way for palliation of dysphagia and TE fistula.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging