Self-expanding metal stents for complicated and recurrent esophagogastric cancer.
BACKGROUND
Fewer complications are encountered with the use of self-expanding metal stents compared with semirigid prostheses in the palliation of patients with malignant esophagogastric obstructions. Metal stents can also be used to treat patients with complicated and/or recurrent esophagogastric carcinoma.


METHODS
Covered metal stents were placed in 57 patients for the following reasons: esophagorespiratory fistula (n = 16), recurrent carcinoma in a gastric tube interposition (n = 21), recurrent carcinoma after partial (n = 4) or total (n = 6) gastrectomy, or a carcinoma near the upper esophageal sphincter (n = 10).


RESULTS
The procedure was technically successful in 55 of 57 (96%) patients. Dysphagia score improved from a mean of 3.6 to 1.6 (p < 0.001). Major complications occurred in 13 (23%) patients. In all cases, esophagorespiratory fistulas were occluded. Tumor recurred in 5 of 16 patients with a fistula, 8 of 21 patients after gastric tube interposition, 3 of 10 patients after gastrectomy, and 2 of 10 patients with a tumor immediately distal to the upper esophageal sphincter. Median survival was 61 days. Prior radiation, chemotherapy, or both increased the risk of specific stent-related complications in relation to the (neo)esophagus (6 of 16 [38%] versus 4 of 41 [10%]: odds ratio, 5.5: 95% CI [1.3, 24], p = 0.018).


CONCLUSIONS
Self-expanding metal stents are effective and relatively safe for palliation of patients with malignancy and dysphagia caused by fistula formation, postoperative recurrence, and tumors near the upper esophageal sphincter. Placement should be considered at an early stage in these conditions.
Siersema
P D
PD
Department of Gastroenterology and Hepatology, University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands.
Schrauwen
S L
SL
van Blankenstein
M
M
Steyerberg
E W
EW
van der Gaast
A
A
Tilanus
H W
HW
Dees
J
J
D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010166:Palliative Care; D011183:Postoperative Complications; D015607:Stents; D013274:Stomach Neoplasms / Q000601:surgery*; D016019:Survival Analysis