Palliation of malignant esophageal strictures with self-expanding nitinol stents: drawbacks and complications.
OBJECTIVE
To evaluate the usefulness of self-expanding nitinol stents in the palliative treatment of malignant dysphagia.


METHODS
Eighty self-expanding nitinol stents were placed in 59 patients (43 men, 16 women; mean age, 55 years; age range, 23-75 years) with inoperable malignant stenosis due to squamous cell carcinoma of the esophagus (n = 36), adenocarcinoma (n = 19), invasion of the esophagus due to carcinoma of the lung (n = 2), and recurrent anastomotic carcinoma (n = 2). Dysphagia was graded on a scale of 0 to 3. Follow-up esophagograms were obtained to evaluate stent patency.


RESULTS
Stent placement was successful in all patients. The severity of dysphagia decreased at least one grade in all but one patient. Tumor ingrowth and overgrowth were seen in 21 (36%) patients 2 days to 7 months after stent placement and caused recurrent dysphagia. These 21 patients underwent balloon dilation and additional stent placement. A mediastinal fistula was seen in three patients (5%), ulceration in four (7%), stent torsion in three (5%), and incomplete expansion of the stent in two (2%). Repeat intervention was necessary in 51% of the patients.


CONCLUSIONS
There is a substantial range of drawbacks and complications associated with the use of self-expanding nitinol stents for palliation of malignant esophageal strictures. A covering would be necessary to prevent tumor ingrowth.
Acunaş
B
B
Istanbul Medical Faculty, Department of Radiology, Turkey.
Rozanes
I
I
Akpinar
S
S
Tunaci
A
A
Tunaci
M
M
Acunaş
G
G
D000230:Adenocarcinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D000328:Adult; D000368:Aged; D000497:Alloys; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D004938:Esophageal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D004940:Esophageal Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004947:Esophagus / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D010166:Palliative Care / Q000379:methods*; D011859:Radiography; D015607:Stents / Q000009:adverse effects
D000497:Alloys; C013616:nitinol