Malignant dysphagia: palliation with esophageal stents--long-term results in 100 patients.
OBJECTIVE
To evaluate the long-term palliative effect of self-expanding nitinol esophageal stents in patients with malignant dysphagia.


METHODS
One hundred patients with severe dysphagia secondary to malignant esophageal strictures were treated with self-expanding nitinol stents. The strictures were caused by squamous carcinoma (n = 43), adenocarcinoma (n = 28), anastomotic tumor recurrence (n = 14), and mediastinal tumor (n = 15).


RESULTS
One hundred six stents were successfully positioned in 100 patients. Attempts to insert a second, coaxial stent were unsuccessful in two patients; a second stent was placed incorrectly in another patient. Statistically significant (P < .001) reduction of dysphagia was noted after expansion of the stents. Complications consisted of incomplete expansion secondary to stent twisting (n = 4), stent migration (n = 4), tumor ingrowth (n = 17), tumor overgrowth (n = 3), food impaction (n = 5), fracture of stent wires (n = 2), benign strictures at stent edges (n = 2), tumor bleeding (n = 3), and esophagorespiratory fistula (n = 5). The primary patency rate was 75% (77 of 102 stents); the secondary patency rate was 94% (96 of 102 stents). The survival time (mean, 6.2 months; range, 0.1-47 months) varied with the diagnosis.


CONCLUSIONS
Placement of self-expanding nitinol stents is safe and has a good long-term palliative effect on dysphagia in patients with malignant esophageal strictures.
Cwikiel
W
W
Department of Radiology, University Hospital, Lund, Sweden.
Tranberg
K G
KG
Cwikiel
M
M
Lillo-Gil
R
R
D000230:Adenocarcinoma / Q000150:complications; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000150:complications; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004867:Equipment Design; D004868:Equipment Failure; D004937:Esophageal Fistula / Q000209:etiology; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D005502:Food / Q000009:adverse effects; D005548:Foreign-Body Migration / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications; D010166:Palliative Care; D016156:Respiratory Tract Fistula / Q000209:etiology; D015607:Stents; D013499:Surface Properties; D015996:Survival Rate
D000497:Alloys; C013616:nitinol