title: Double layered self-expanding metal stents for malignant esophageal obstruction, especially across the gastroesophageal junction.
abstract: OBJECTIVE
  To evaluate the clinical outcomes of double-layered self-expanding metal stents (SEMS) for treatment of malignant esophageal obstruction according to whether SEMS crosses the gastroesophageal junction (GEJ).
  
  
  METHODS
  Forty eight patients who underwent the SEMS insertion for malignant esophageal obstruction were enrolled. Patients were classified as GEJ group (SEMS across GEJ, 18 patients) and non-GEJ group (SEMS above GEJ, 30 patients) according to SEMS position. Double layered (outer uncovered and inner covered stent) esophageal stents were placed.
  
  
  RESULTS
  The SEMS insertion and the clinical improvement were achieved in all patients in both groups. Stent malfunction occurred in seven patients in the GEJ group and nine patients in the non-GEJ group. Tumor overgrowth occurred in five and eight patients, respectively, food impaction occurred in one patient in each group, and stent migration occurred in one and no patient, respectively. There were no significant differences between the two groups. Reflux esophagitis occurred more frequently in the GEJ group (eight vs five patients, P = 0.036) and was controlled by proton pump inhibitor. Aspiration pneumonia occurred in zero and five patients, respectively, and tracheoesophageal fistula occurred in zero and two patients, respectively.
  
  
  CONCLUSIONS
  Double-layered SEMS are a feasible and effective treatment when placed across the GEJ for malignant esophageal obstruction. Double-layered SEMS provide acceptable complications, especially migration, although reflux esophagitis is more common in the GEJ group.
authors.affiliation: Department of Internal Medicine, Bongseng Memorial Hospital, Busan 601-723, South Korea.
authors.forename: Min Dae
authors.initials: MD
authors.lastname: Kim
authors.forename: Su Bum
authors.initials: SB
authors.lastname: Park
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Lee
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Choi
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.forename: Chung Uk
authors.initials: CU
authors.lastname: Chung
authors.forename: Young Il
authors.initials: YI
authors.lastname: Jeong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods; D004867:Equipment Design; D004935:Esophageal Diseases / Q000601:surgery* / Q000628:therapy; D004940:Esophageal Stenosis / Q000601:surgery* / Q000628:therapy; D004942:Esophagitis, Peptic / Q000601:surgery / Q000628:therapy*; D004943:Esophagogastric Junction / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005762:Gastroenterology / Q000379:methods; D006801:Humans; D008297:Male; D008670:Metals / Q000737:chemistry*; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome
chemical_list: D008670:Metals