title: Mid-esophagus unresectable cancer treated with a low cost stent. First experience.
abstract: BACKGROUND
  In the cancer of the esophagus, with recent technologic advances, self-expanding metal stents (SEMS) are at the forefront of the armamentarium for re-establishing luminal patency. Weighed against the numerous advantages of stents are the import conditions and the cost. In light of this, we tested new low cost prostheses having the basic needs and characteristics to aim a significant benefit to poor people having advanced esophageal cancer, in a Brazilian regional public hospital.
  
  
  METHODS
  This initial experience included fifteen patients (eleven men and four women, 55 ± 6.17 years old), presenting esophageal cancer, located at the medium third of the thoracic esophagus, extending for 5.5-8 cm long, not suitable for surgical procedure because they had been staged on fourth grade of the disease, two of them having fistula communicating esophagus to respiratory tree. The stents were placed under endoscopic and fluoroscopic guidance, after attempting an esophageal dilatation. An appropriate covered stent was then deployed, twelve of 10 cm and three of 13 cm in length. A chest X-ray was done 2 h after the procedure and a barium swallow was performed within 12 hours. Seven days and monthly until complete a six month follow-up after the procedure the patients were questioned about presence of pain, regurgitation, heartburn, cough, and their alimentary behavior.
  
  
  RESULTS
  There were no severe complications and transient mild chest pain resolved until the seventh day after the stent deployment. Chest X-ray demonstrated expansion of the stent in all patients. In 2 cases of fistula, a barium swallow showed its complete sealing. The completion of the proposed follow-up was not achieved in three cases, limited by the patient's death until the third month, due to cancer progression. Recurrent dysphagia to paste food accounted for by tumor overgrowth proximal or distal to the stent and stent migration were not observed in the series.
  
  
  CONCLUSIONS
  The new low cost endoprostheses is effective and forthcoming increased experience and prospective trials including questionnaires to analyze quality of life will allow for more informed decisions tailoring to a particular patient situation or to unexpected complications.
authors.affiliation: Department of Gastroenterology, Surgical Division, University of São Paulo, School of Medicine (FMUSP), Rua Frei Caneca, 1407, c, 221, São Paulo, ZC 01307-909, Brazil. v.felix@terra.com.br.
authors.forename: Valter N
authors.initials: VN
authors.lastname: Felix
authors.forename: Alaor
authors.initials: A
authors.lastname: Caetano
authors.forename: Jose P
authors.initials: JP
authors.lastname: Cipullo
authors.forename: Emiliano C
authors.initials: EC
authors.lastname: Almodova
authors.forename: Wagner
authors.initials: W
authors.lastname: Colaiacovo
authors.forename: Aldenir F
authors.initials: AF
authors.lastname: Zamboti
references.citation: Gastrointest Endosc. 1996 May;43(5):478-82
references.pmid: 8726762
references.citation: Am J Gastroenterol. 2009 Jul;104(7):1674-85
references.pmid: 19436289
references.citation: Gut. 1994 Jul;35(7):941-5
references.pmid: 7794305
references.citation: Dis Esophagus. 2005;18(4):230-8
references.pmid: 16128779
references.citation: Am J Gastroenterol. 2001 Jun;96(6):1791-6
references.pmid: 11419831
references.citation: N Engl J Med. 1993 Oct 28;329(18):1302-7
references.pmid: 7692297
references.citation: Eur J Gastroenterol Hepatol. 1998 Aug;10(8):653-7
references.pmid: 9744693
references.citation: Expert Rev Med Devices. 2007 Sep;4(5):741-52
references.pmid: 17850208