Self-expanding metal stents for endoscopic treatment of esophageal achalasia unresponsive to conventional treatments. Long-term results in eight patients.
OBJECTIVE
The successful use of self-expanding metal stents has been demonstrated in the management of malignant esophagocardial strictures. This report assesses the role stents may play in the treatment of esophageal achalasia in selected patients.


METHODS
Between September 1996 and December 1997, eight patients (two men, six women; average age 67.6 years) underwent insertion of a self-expanding metal stent for management of achalasia. Previous myotomy and/or balloon dilation or injection of botulinum toxin had failed in all patients. Four nitinol coil stents and five covered Ultraflex stents, 10 cm long, were inserted, being passed through the gastroesophageal junction under mild sedation.


RESULTS
Stent placement was successful and uncomplicated in all patients. Early complications were seen in five patients: chest pain (1), gastroesophageal reflux (1), proximal migration (1), and distal migration (2). One patient underwent surgery for stent impaction in the colon. During the follow-up period of 35.5 months, on average (range 29 - 44 months), four patients experienced complications: chest pain (2), reflux esophagitis (1) and stent migration (1).


CONCLUSIONS
General use of self-expanding metal stents for esophageal achalasia cannot be recommended.
De Palma
G D
GD
Digestive Endoscopy Service, Dept. of Surgery and Advanced Technologies, School of Medicine, University Federico II, Via De Gasperi, N.7, 80033 Cicciano, Naples, Italy. gdepalma@arrotino.it
lovino
P
P
Masone
S
S
Persico
M
M
Persico
G
G
D000368:Aged; D000369:Aged, 80 and over; D004931:Esophageal Achalasia / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome