Malignant esophageal-tracheobronchial strictures: parallel placement of covered retrievable expandable nitinol stents.
OBJECTIVE
To assess the safety and clinical effectiveness of the parallel placement of covered retrievable expandable metallic stents in the palliative treatment of malignant esophageal and tracheobronchial strictures.


METHODS
Under fluoroscopic guidance, parallel stents were placed in 12 symptomatic patients with both malignant esophageal and tracheobronchial strictures. Seven of these 12 patients also had an esophagorespiratory fistula (ERF) and one patient had an esophagocutaneous fistula. Technical success, clinical improvement, complications, and survival rates were evaluated.


RESULTS
A total of 28 esophageal and airway stents were successfully placed. The grade of dysphagia and dyspnea score significantly decreased after stent placement (P=0.002 and 0.003, respectively). ERF and esophagocutaneous fistula were sealed off in all eight patients after esophageal stent placement; however, the esophagocutaneous fistula reopened 1 month later. Complications included stent migration or expectoration (n=3), tracheal compression by the esophageal stent (n=3), new fistula development due to covering membrane degradation of the esophageal stent (n=1), and symptomatic sputum retention (n=1). Stent removal was easily performed for two stents; one migrated stent and the other with covering membrane degradation. All 12 patients died within the mean survival period of 72.50 days (range 7-375 days).


CONCLUSIONS
Parallel placement of covered retrievable expandable metallic stents is safe and effective for the palliative treatment of malignant esophageal and tracheobronchial strictures.
Department of Radiology, Soonchunhyang University Chonan Hospital, College of Medicine, Soonchunhyang University, Republic of Korea.
D H
DH
Nam
J H
JH
Shin
H Y
HY
Song
G S
GS
Jung
Y M
YM
Han
D000328:Adult; D000368:Aged; D000497:Alloys / Q000627:therapeutic use*; D001982:Bronchial Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003251:Constriction, Pathologic / Q000209:etiology / Q000401:mortality / Q000628:therapy; D004937:Esophageal Fistula / Q000209:etiology / Q000628:therapy; D004940:Esophageal Stenosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D015996:Survival Rate; D014132:Trachea / Q000000981:diagnostic imaging / Q000601:surgery; D014135:Tracheal Stenosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
D000497:Alloys; C013616:nitinol