Malignant esophageal obstruction and esophagorespiratory fistula: palliation with a polyethylene-covered Z-stent.
OBJECTIVE
To prospectively evaluate the clinical efficacy of polyethylene-covered metallic Z-stents in treatment of dysphagia secondary to malignant esophageal obstruction and esophagorespiratory fistula.


METHODS
Thirty-five patients with dysphagia due to malignant esophageal obstruction (n = 32) and esophagorespiratory fistula (n = 3) were treated with polyethylene-covered Gianturco-Rösch Z-stents.


RESULTS
Thirty-nine stents were placed in 35 patients. Stent placement was technically successful in all patients. Improvement in dysphagia was achieved in 34 of 35 patients. The average dysphagia score decreased from 3.1 (dysphagia to liquids) to 0.6 (essentially normal diet). An esophagorespiratory fistula was completely sealed in two of three patients. All 35 patients were followed up clinically at 1 day and 1 week and at 3-month intervals (range, 1 week to 18 1/2 months; mean, 4.8 months). Recurrent dysphagia or aspiration occurred in only three of 34 (9%) patients whose disease was initially palliated and was easily treated in all cases. Nine complications occurred in eight patients (23%) and included chest pain that required analgesia (n = 3), food impaction (n = 1), stent migration (n = 2), and upper gastrointestinal tract hemorrhage (n = 3).


CONCLUSIONS
Polyethylene-covered stents are a relatively safe and effective means of long-term palliation in patients with severe malignant esophageal obstruction and esophagorespiratory fistula. These stents are easily deployed, and the rate of stent migration is relatively low.
Saxon
R R
RR
Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201-3098, USA.
Morrison
K E
KE
Lakin
P C
PC
Petersen
B D
BD
Barton
R E
RE
Katon
R M
RM
Keller
F S
FS
D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004937:Esophageal Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications / Q000628:therapy*; D004940:Esophageal Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004947:Esophagus; D005260:Female; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011095:Polyethylenes; D011446:Prospective Studies; D015641:Radiography, Interventional; D012142:Respiratory Tract Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015607:Stents / Q000009:adverse effects
D011095:Polyethylenes