Photodynamic therapy for the treatment of tumor ingrowth in expandable esophageal stents.
OBJECTIVE
Tumor ingrowth through self-expanding metal stents presents a difficult problem for management. The techniques for treating tumor ingrowth have not yet been well described, and the optimal endoscopic approach is not clear. We have recently used photodynamic therapy (PDT) to treat tumor ingrowth through uncovered nitinol mesh stents.


METHODS
Four patients (mean age 73) with obstructive adenocarcinomas of the distal esophagus had received self-expanding stents for palliation of their dysphagia. After stent placement, tumor ingrowth had caused progressive dysphagia in all of the patients; the dysphagia was graded on a scale from 0 (normal) to 4 (inability to swallow liquids). All of the patients received PDT treatment.


RESULTS
After PDT, excellent palliation of the dysphagia was seen in all of the patients, with a mean improvement in the dysphagia score of 2.25 and a mean dysphagia-free interval of 92 days. There were no major complications.


CONCLUSIONS
The use of PDT to treat tumor ingrowth through self-expanding metal esophageal stents is effective and safe.
Scheider
D M
DM
Center for Therapeutic Endoscopy and Endoscopic Oncology, Wellesley Hospital, Toronto, Canada.
Siemens
M
M
Cirocco
M
M
Haber
G B
GB
Kandel
G
G
Kortan
P
P
Marcon
N E
NE
D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys / Q000009:adverse effects; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D004940:Esophageal Stenosis / Q000209:etiology / Q000517:prevention & control; D004945:Esophagoscopy; D005260:Female; D005549:Foreign-Body Reaction / Q000209:etiology / Q000517:prevention & control; D017324:Hematoporphyrin Derivative / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011379:Prognosis; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate
D000497:Alloys; D017319:Photosensitizing Agents; C013616:nitinol; D017324:Hematoporphyrin Derivative