title: Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study.
abstract: BACKGROUND
  This study aimed to investigate the efficacy and safety of placing self-expandable metal stents (SEMSs) without fluoroscopy for palliation of malignant esophageal or esophagogastric strictures.
  
  
  METHODS
  From January 2003 to June 2008, a prospective observational study investigated the placement of covered proximal-release Ultraflex stents without fluoroscopy in nonoperable malignant esophageal and esophagogastric strictures. The technical success as well as the early and late complications (perforation, migration, severe gastroesophageal reflux, hematemesis, and reobstruction due to tissue ingrowth or overgrowth) were recorded. Dysphagia before and after stent placement was scored on a 5-point scale. All the patients were observed monthly in the outpatient clinic or by telephone contact until death.
  
  
  RESULTS
  The study enrolled 89 patients (16 women; mean age, 69.54±7.1 years) with dysphagia due to inoperable esophageal or esophagogastric malignant strictures (29 squamous cell cancers, 52 adenocarcinomas, and 8 obstructive malignant extrinsic compressions). The mean stricture length was 6.2±2.8 cm. Endoscopic deployment was achieved for 83 patients (93.2%), with accurate stent positioning in all the patients except one. An adequate relief of symptoms was noted for 82 of the patients (92.1%). During the follow-up period, 36 patients (43.4%) had recurrent dysphagia, caused by tumor overgrowth in 32 cases and stent migration in 4 cases, after an average time of 82 days (range 67-216 days). A stent-in-stent procedure was performed in 27 cases. For two patients, a third stent-in-stent needed to be placed after 85 and 216 days, respectively.
  
  
  CONCLUSIONS
  In most cases, SEMSs can be accurately and safely positioned without fluoroscopy for palliative treatment of malignant esophageal dysphagia.
authors.affiliation: Department of Gastrointestinal Oncology, Theagenion Cancer Hospital, Al. Simeonidi 2 str, 54007, Thessaloniki, Greece. lazarakg@yahoo.com
authors.forename: Georgia
authors.initials: G
authors.lastname: Lazaraki
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Katsinelos
authors.forename: Andreas
authors.initials: A
authors.lastname: Nakos
authors.forename: Grigoris
authors.initials: G
authors.lastname: Chatzimavroudis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Pilpilidis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Paikos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tzilves
authors.forename: Ioannis
authors.initials: I
authors.lastname: Katsos
mesh_terms: D020099:Coated Materials, Biocompatible; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications / Q000628:therapy*; D004940:Esophageal Stenosis / Q000150:complications / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D019919:Prosthesis Implantation; D011788:Quality of Life; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible