[Highly flexible self-expanding metal mesh stents: a new kind of palliative therapy of malignant dysphagia].
Metal mesh stents are a new way in the treatment of malignant stenoses. Between 11/91 and 12/93 in 79 patients with malignant stenoses of the esophagus and the esophago-gastric junction 96 highly elastic, knitted, self-expanding nitinol stents (Ultraflex, Boston Scientific) were implanted. Most of the tumors being problematic, preoperated or preradiated, in 78 of 96 implantations endoscopic pretreatment (Laser, Argon Plasma Coagulation (APC), dilatation)--mostly in the same session--was necessary. Follow up time was 21 (2-108) weeks. In this pilot study 3.5 (1-27) controlendoscopies with 2.5 (1-10) endoscopic interventions were performed. 90 of 96 implantations were primarily successful and led to a functional success in 73 of 79 patients. The ability to swallow improved significantly, the score of dysphagia improved from 3.5 to 1.0 (p < 0.001). There were no relevant complications and no stent-related mortality. All stents could be kept patent during the follow up period using the new developed Argon-plasma-coagulation (APC) to treat the ingrowth of granulation tissue or tumor, which was observed during follow up in 72 of 93 implantations. Tumor ingrowth represents the main problem of the method and demands endoscopic posttreatment (APC) in cases with relevant re-obstruction. Impairment of the stent lumen by tumor ingrowth (granulation tissue plays no role) would have been observed in about 60% of the patients without such a treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Grund
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Abt. Allgemeinchirurgie, Chirurgische Universitätsklinik Tübingen.
Storek
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Zindel
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Becker
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HD
D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D003680:Deglutition Disorders / Q000628:therapy*; D004548:Elasticity; D004564:Electrocoagulation; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000628:therapy*; D004940:Esophageal Stenosis / Q000628:therapy*; D020701:Esophagoscopes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000331:legislation & jurisprudence*; D010865:Pilot Projects; D015607:Stents; D013499:Surface Properties
D000497:Alloys; C013616:nitinol
Hochflexible selbstexpandierende Metallgitterstents: Neuartige Palliativtherapie der malignen Dysphagie.