Palliation of malignant esophageal obstruction and fistulas with self expandable metallic stents.
OBJECTIVE
To evaluate the efficacy of self expandable metallic stents (SEMS) in patients with malignant esophageal obstruction and fistulas.


METHODS
SEMS were implanted in the presence of fluoroscopic guidance in patients suffering from advanced and non-resectable esophageal, cardiac and invasive lung cancer between 2002 and 2009. All procedures were performed under conscious sedation. All patients had esophagus obstruction and/or fistula. In all patients who required reintervention, recurrence of dysphagia, hemorrhage, and fistula formation were indications for further endoscopy. Patients' files were scanned retrospectively and the obtained data were analyzed using SPSS 13.0 for Windows. The χ(2) test was used for categorical data and was analysis of variance for non-categorical data. Patients' long-term survival was assessed using the Kaplan-Meier method.


RESULTS
Stents were successfully implanted in 90 patients using fluoroscopic guidance. Reasons for stent implantation in these patients were esophageal stricture (77/90, 85.5%), external pressure (8/90, 8.8%) and tracheo-esophageal fistula (5/90, 5.5%). Dysphagia scores (mean ± SD) were 3.37 ± 0.52 before and 0.90 ± 0.43 after stent implantation (P = 0.002). Intermittent, non-massive hemorrhage due to the erosion caused by the distal end of the stent in the stomach occurred in only one patient who received implementation at cardio-esophageal junction. Mean survival following stenting was 134.14 d (95% confidence interval: 94.06-174.21).


CONCLUSIONS
SEMS placement is safe and effective in the palliation of dysphagia in selected patients with malignant esophageal strictures.
Division of Gastroenterology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul 34300, Turkey. adobrucali@yahoo.com
Ahmet
A
Dobrucali
Erkan
E
Caglar
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D016009:Chi-Square Distribution; D016292:Procedural Sedation; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004938:Esophageal Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D004940:Esophageal Stenosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004945:Esophagoscopy / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010166:Palliative Care; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D013997:Time Factors; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D014421:Turkey
D008670:Metals