Ultraflex stent--benefits and risks in ultimate palliation of advanced, malignant stenosis in the esophagus.
OBJECTIVE
Sophisticated endoscopical palliation in end-stage malignant stenosis of the esophagus and gastroesophageal-junction must be weighed against associated morbidity and mortality. In a prospective study we investigated benefits and risks of one type of coated, self-expandable stent in ultimate palliation of esophageal neoplasms focusing on factors that might predispose patients to develop complications.


METHODS
33 men (70.2%) and 14 women (29.8%), (mean age 68.3 years, range from 38 to 90 years), suffering from nonresectable malignant stenosis of the esophagus due to advanced tumor stage and/or functional inoperability were treated by using a covered, self-expandable stent (covered ULTRAFLEX esophageal stent system, Microinvasive, Boston Scientific Corporation, Boston, MA). Stenting was indicated because of severe dysphagia for liquids and saliva in 41 (87.2%) patients, tracheoesophageal fistula in 5 (10.6%) patients and in one case of tumor bleeding (2.1%). 32 out of 47 patients had had one or other multiple treatment modalities before stenting. In 15 patients stenting was the first and only therapeutic option.


RESULTS
All patients experienced an improvement of dysphagia immediately after stenting. Eight out of 47 patients (17.1%) developed major stent-associated complications: Early complications within 4 days after implantation evolved in two cases, with one patient dying from stent-induced perforation with consecutive mediastinitis and multi-organ failure. Late complications (20 to 180 days after stent implantation) occurred in 6 cases: Three esophagotracheal fistulae (two with tracheal compression) induced by stent expansion, one stent-induced bleeding and two stent dislocations. After appropriate complication management all but two patients were able to be discharged after a mean of 2.6 days. Multivariate analysis did not show any factors that might have predicted the development of major stent-associated complications.


CONCLUSIONS
Implantation of the self-expandable Ultraflex-stent will efficiently palliate dysphagia, bleeding and fistulae. The 17% risk of major complications seems acceptable regarding the inherent problems of alternative treatment options, like gastrostomy, PEG, nasogastric tube or long-term parenteral feeding.
Tomaselli
Florian
F
Department of Surgery, Division of Thoracic and Hyperbaric Surgery, University Medical School, Graz, Austria. florian.tomaselli@kfunigraz.ac.at
Maier
Alfred
A
Sankin
Oliver
O
Pinter
Hans
H
Smolle
Josef
J
Smolle-Jüttner
Freyja Maria
FM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020099:Coated Materials, Biocompatible; D003680:Deglutition Disorders / Q000209:etiology*; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000150:complications* / Q000473:pathology; D004940:Esophageal Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010166:Palliative Care; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible