Expandable metal stents in achalasia--is there a role?
OBJECTIVE
Achalasia is treated with pneumatic dilation or myotomy, and botulinum toxin injections are occasionally used. We review our community's experience with expandable metal stents in six patients who failed medical treatment or were poor surgical candidates.


METHODS
Eight stents were placed in six patients between July 1995 and November 1997. Four patients had achalasia and two pseudoachalasia. Four patients underwent successive botulinum toxin injections. One patient only agreed to periodic Maloney dilatations or a stent. Pneumatic dilation was performed in one patient and considered high risk in the rest. All were poor surgical candidates. Three different stents were used: Gianturco Rosch Z stent, Wallstent I, and Wallstent II.


RESULTS
One-month mortality and morbidity were 33% and 50%, respectively. Two patients were asymptomatic on a liquid diet for > or =6 months but required repeat endoscopy for recurrent dysphagia because of food bolus impaction and proximal stent migration in each.


CONCLUSIONS
Expandable metal stents in achalasia or pseudoachalasia do not provide sustained symptom relief, and their use is associated with unacceptably high morbidity and mortality. We do not recommend the use of these devices in patients who have failed medical therapy or who are poor surgical candidates.
Mukherjee
S
S
Department of Medicine, State University of New York Health Science Center at Syracuse, USA.
Kaplan
D S
DS
Parasher
G
G
Sipple
M S
MS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D004867:Equipment Design; D004931:Esophageal Achalasia / Q000150:complications / Q000401:mortality / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D020959:Polyethylene; D011379:Prognosis; D012189:Retrospective Studies; D055502:Secondary Prevention; D013193:Stainless Steel; D015607:Stents; D015996:Survival Rate
D020099:Coated Materials, Biocompatible; D013193:Stainless Steel; D020959:Polyethylene