Self-expandable metal stents for malignant dysphagia.
BACKGROUND
The use of self-expandable metal stents in relieving dysphagia for patients with incurable malignant oesophageal strictures was retrospectively evaluated.


METHODS
Between September 1993 and August 1996, 66 male and 16 female patients with a median age of 72 years received self-expandable metal stents for malignant dysphagia. Six patients had concurrent tracheo-oesophageal fistulas. All patients were stented under sedation and stent insertion was performed under fluoroscopic guidance.


RESULTS
Stent placement was successful in 80 patients (98%). There were seven early complications (inaccurate positioning (n = 3), migration (n = 1), incomplete expansion (n = 1), intractable pain (n = 1), and perforation (n = 1)). Two complications were lethal and three were treated endoscopically. Mean dysphagia grade improved from 3.2+/-0.7 to 1.8+/-0.9 (P < 0.05) after implantation. All tracheo-esophageal fistulas were successfully occluded. Upon a median follow-up of 8 weeks (range: 2-20 weeks), 30 complications developed in 21 patients (tumour overgrowth (n = 15), food bolus obstruction (n = 7), tumour ingrowth (n = 2), buckling of stent (n = 2), tracheo-esophageal fistula (n = 2), bleeding (n = 1), and gastric wall herniation through metal coils (n = 1)). Median survival was 13 weeks (range: 1-82 weeks).


CONCLUSIONS
Self-expandable metal stents provide useful palliation in patients with incurable malignant dysphagia.
Lam
Y H
YH
Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT.
Chan
A
A
Lau
J
J
Lee
D
D
Ng
E
E
Wong
S
S
Chung
S
S
D000230:Adenocarcinoma / Q000139:chemically induced / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000473:pathology; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000473:pathology; D004940:Esophageal Stenosis / Q000150:complications* / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents