title: Self-expandable metallic stent for unresectable malignant strictures in the esophagus and cardia.
abstract: OBJECTIVE
  Self-expandable metallic stent (EMS) placement has been the first choice for dysphagia because of the certainty over its safety, low invasiveness, and immediate efficacy. However, there still remain some problems in relation to the EMS placement site and anticancer therapies before and after EMS placement.
  
  
  METHODS
  Consecutive 78 patients in whom EMS was placed due to the unresectable malignant stricture in the esophagus or cardia from July 1995 to August 2003 in our department were studied.
  
  
  RESULTS
  Gastroesophageal reflux was found in 5 of 8 patients after placement of conventional EMS for the stricture in the gastroesophageal junction. Meanwhile, acid and bile reflux into the esophagus were not detected by pH and bilirubin monitoring, respectively, in 6 patients after placement of the EMS with an anti-reflux mechanism for the stricture in the gastroesophageal junction. The median survival period of all patients after EMS placement was 123 days. The median survival period of 7 patients with radiotherapy only after EMS placement was 138 days and that of 17 patients with radiotherapy before EMS placement was 60 days, which was shorter than that of the former (p<0.05). On the other hand, the median survival period after hospital admission due to dysphagia of these 7 patients was longer than that of 17 patients with radiotherapy only before EMS placement, although, the difference was not significant.
  
  
  CONCLUSIONS
  EMS with an antireflux mechanism is not commercially available in Japan and approval is urgently required. The indication of radiotherapy associated with EMS placement is to be studied further.
authors.affiliation: Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Lee
authors.forename: Harushi
authors.initials: H
authors.lastname: Osugi
authors.forename: Taigo
authors.initials: T
authors.lastname: Tokuhara
authors.forename: Masashi
authors.initials: M
authors.lastname: Takemura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kaneko
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Yushi
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nishizawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iwasaki
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Suehiro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia; D003680:Deglutition Disorders / Q000209:etiology / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000401:mortality / Q000532:radiotherapy; D004940:Esophageal Stenosis / Q000209:etiology / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D004943:Esophagogastric Junction; D005260:Female; D005764:Gastroesophageal Reflux; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors