title: Feasibility, efficacy and safety of stent insertion as a palliative treatment for malignant strictures in the cervical segment of the esophagus and the hypopharynx.
abstract: BACKGROUND
  50% of esophageal cancers are inoperable at the time of diagnosis, and around 15% involve the cervical esophagus. The hypopharynx is often involved by these malignancies as well. Palliation of cervical esophageal malignancies through stent insertion is considered limited due to technical challenges, poor patient tolerance and high complication rate. The aim of this study is to review our experience with stent insertion in the cervical segment of the esophagus and to evaluate outcome differences between stent insertions involving or sparing the hypopharynx.
  
  
  METHODS
  We retrospectively reviewed data on 69 consecutive patients that underwent stent insertion for malignant strictures in the cervical esophagus at our Department. Patients were divided according to involvement or sparing of the lower hypopharynx. Dysphagia severity was measured with the Mellow-Pinkas scale before the procedure and on monthly follow-ups. Any complication and its management were recorded. The main outcome parameters were as follows: dysphagia improvement, rate of successful dysphagia palliation (i.e., a reduction of the score to 0 or 1 after stent insertion) and complication rate. Multivariable analysis was carried out to assess the influence of patient- and procedure-related factors on the outcome of the procedure.
  
  
  RESULTS
  Stent insertion was achieved in 100% patients. At 4 weeks, dysphagia score improved from a median of 3-0 (p < 0.001), and a successful palliation was achieved in 76.8% patients. The 30-day mortality rate was 14.5%. Successful palliation throughout the follow-up was achieved in 72.9% of the surviving patients. Complications occurred in 31.9% patients. Dilation before stent insertion was associated with a less efficient short-term dysphagia palliation (OR 6.77, 95% CI 1.46-31.29, p = 0.02).
  
  
  CONCLUSIONS
  Stent insertion is a safe and effective palliative treatment for malignant cervical esophageal strictures. Results are consistent even in patients with hypopharyngeal lesions. Dilation should be avoided before stent insertion.
authors.affiliation: Digestive Endoscopy Unit, Veneto Institute of Oncology IOV - I.R.C.S.S., Padua, Italy. giorgio.battaglia@unipd.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Battaglia
authors.affiliation: Digestive Endoscopy Unit, Veneto Institute of Oncology IOV - I.R.C.S.S., Padua, Italy. alessandro.antonello@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonello
authors.affiliation: Digestive Endoscopy Unit, Veneto Institute of Oncology IOV - I.R.C.S.S., Padua, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Realdon
authors.affiliation: Surgical Oncology Department, Veneto Institute of Oncology IOV - I.R.C.S.S., Padua, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavallin
authors.affiliation: Digestive Endoscopy Unit, Veneto Institute of Oncology IOV - I.R.C.S.S., Padua, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Giacomini
authors.affiliation: Gastroenterology Department, Dudley Group Hospitals, Birmingham City University, Birmingham, UK.|Department of Medicine, St. George's University, Grenada, West Indies.
authors.forename: Sauid
authors.initials: S
authors.lastname: Ishaq
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D004945:Esophagoscopy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007013:Hypopharynx / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D015607:Stents
keywords: Endoscopy, gastrointestinal; Esophageal neoplasms; Esophageal sphincter, upper; Palliative care; Stents
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