Self-expanding metal stents for malignant esophagogastric obstruction: experience with a new design covered nitinol stent.
OBJECTIVE
Dysphagia is the most common disabling symptom in patients with inoperable esophagogastric carcinoma. Self-expanding metal stents are highly effective in the palliation of these patients.


METHODS
In 35 patients with inoperable carcinoma of the esophagus or the stomach, with recurrent tumor or complications after transhiatal esophagectomy or gastrectomy or with esophageal stenosis caused by pulmonary cancer, a self-expanding nitinol stent was placed to reduce dysphagia. Dysphagia and WHO performance status were assessed, before and after stent placement.


RESULTS
In 35 patients, 39 stents were placed without technical problems. Dysphagia improved significantly. The WHO performance status remained stable. Mean survival of all patients was 11 weeks. Major complications occurred in 3 patients. One patient died of massive tumor bleeding. Minor complications such as stent migration or retrosternal pain occurred in 5 patients. In 2 patients the migrated stent could successfully be placed in the correct position after giving ice-cooled water through the endoscope. Four patients had esophagorespiratory fistulas which were all initially successfully occluded.


CONCLUSIONS
This nitinol stent is highly effective for improving dysphagia in patients with malignant esophagogastric obstruction. We observed no procedure-related complications. Bleeding was the principal major complication. The early intake of cold beverages resulted in stent migration. Recurrent dysphagia due to overgrowth by tumor or nonmalignant tissue remains a problem. Technical improvements are desirable to reduce the overgrowth by nonmalignant tissue.
Keller
Ralf
R
Department of Medicine II, Hospital of Aschaffenburg, Aschaffenburg, Germany. r.keller@mathias-spital.de
Flieger
Dimitri
D
Fischbach
Wolfgang
W
Christl
Stefn Ulrich
SU
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D003680:Deglutition Disorders / Q000209:etiology* / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D019919:Prosthesis Implantation / Q000379:methods; D018709:Statistics, Nonparametric; D015607:Stents / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery; D013997:Time Factors; D014944:World Health Organization
D000497:Alloys; C013616:nitinol