Large diameter fully covered self-expanding metal stent placement for palliation of proximal malignant esophageal strictures.
In patients with malignant esophageal strictures within 6 cm from the upper esophageal sphincter, self-expanding metal stents placement represents a challenge because there is an increased risk of complications. The aim of this study was to assess the safety and effectiveness of large-diameter WallFlex(®) fully covered self-expanding metal stents for palliation of patients with proximal malignant esophageal strictures. From March 2010 to December 2012, 12 patients with proximal strictures (4-6 cm from the upper esophageal sphincter) and six with very proximal strictures (<4 cm from the upper esophageal sphincter) were palliated with this fully covered self-expanding metal stent and included in the study. Technical success was 100% and clinical success was 94%. The mean baseline dysphagia score was 3.2, and 1 week after stenting it improved significantly to 1.3 (P < 0.001). Early complications occurred in four patients, more frequently in patients with very proximal strictures as compared with patients with proximal strictures (P = 0.02). Late complications occurred in five patients, and there were no differences between patients with very proximal strictures or proximal strictures (P = 0.245). The mean survival after stent placement was 119 days, and no differences between patients with very proximal strictures versus proximal strictures were found (P = 0.851). There was no stent-related mortality or 30-day mortality. Our results suggested that a large-diameter fully covered self-expanding metal stent is an effective and secure device for palliation of patients with proximal malignant esophageal strictures.
Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bologna, Italy.
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M
Bassi
Unit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi, Catania, Italy.
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C
Luigiano
Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bologna, Italy.
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C
Fabbri
Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bologna, Italy.
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Ferrara
Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bologna, Italy.
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Ghersi
Department of Statistics, University of Messina, Messina, Italy.
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Alibrandi
Department of Clinical Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy.
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Fuccio
Unit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi, Catania, Italy.
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C
Virgilio
Thoracic Endoscopy and Pulmonology Unit, Maggiore Hospital, Bologna, Italy.
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M
Patelli
Anesthesia and Intensive Care, IRCCS Istituto delle Scienze Neurologiche Bellaria Hospital, Bologna, Italy.
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Zanello
Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bologna, Italy.
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Cennamo
D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D049631:Esophageal Sphincter, Upper / Q000601:surgery; D004940:Esophageal Stenosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects / Q000706:statistics & numerical data*; D016896:Treatment Outcome
esophageal cancer; fully covered self-expanding metal stent; palliation; stricture