Esophacoil expanding stent in the management of patients with nonresectable malignant esophageal or cardiac neoplasm: a prospective study.
OBJECTIVE
In this prospective study we evaluated the use of the self-expanding Esophacoil stent for palliation in patients with non-resectable malignant tumors of the cardia and esophagus. The stent has some obvious advantages from a theorectical point of view, namely a wide diameter and strong forces of expansion and retraction, which prevent migration and tumor overgrowth. Its considerable flexibility facilitates insertion of the stent into tortuous and angulated passages.


METHODS
A total of 30 patients participated in the study. The tumor was located in the lower esophagus or cardia in 15 patients, in the mid-esophagus in six and in the upper oesophagus in two patients. More than two-thirds of the esophagus was involved in three patients and four had a recurrence in an esophagogastric anastomosis.


RESULTS
The procedure was successful in 29 of 30 patients. The overall hospital mortality was 10%. One death from gastrointestinal haemorrhage following insertion of the stent was directly procedure-related. The morbidity related to the procedure was 10%. The median time in hospital after stent insertion was 1 day (range 1-9). All the patients could manage a semi-solid diet after stent insertion. Survival after discharge did not exceed 8 months and the median survival was 63 days. Of the patients, 22 (81 %) needed no further intervention or hospital admission because of the stents. Three had tumor overgrowth or ingrowth, and one stent migrated after the patient was discharged and passed spontaneously per anum.


CONCLUSIONS
Insertion of an Esophacoil metal stent into malignant strictures of the esophagus and cardia is a fairly simple and safe procedure. Dysphagia is significantly relieved, initially, with few long-term side effects. In the short span of time left for the patients, the need for further treatment after discharge is minimal, but swallowing ability gradually deteriorates in the terminal phase.
Olsen
E
E
Dept. of Surgery, Viborg Hospital, Denmark. eyo@dadlnet.dk
Thyregaard
R
R
Kill
J
J
D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001672:Biocompatible Materials; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002299:Cardia / Q000601:surgery; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D019919:Prosthesis Implantation; D015607:Stents; D013274:Stomach Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*
D001672:Biocompatible Materials