title: Self-expanding metallic stent placement with an exaggerated 5-cm proximal tumor covering for palliation of esophageal cancer.
abstract: BACKGROUND
  The study aimed to evaluate the short- and long-term outcomes with a technique of self-expanding metallic stent insertion in palliative esophageal cancer patients. We hypothesized that a systematic attempt at exaggerated (5 cm) proximal tumor covering could prevent both stent migration and tumor overgrowth/undergrowth.
  
  
  METHODS
  We reviewed retrospectively all patients who underwent esophageal stenting for palliation of malignant dysphagia over a 24-month period. Consecutive patients were identified from a prospective thoracic surgery interventional endoscopy database. This technique consisted of endoscopic stent insertion with the aim of landing the proximal portion of the stent 5 cm cephalad to the proximal extent of the tumor. All patients were followed at one month post-procedure and every three months thereafter, until death. Short- and long-term complications associated with the procedure and mortality were evaluated.
  
  
  RESULTS
  Forty seven patients underwent endoscopic insertion of an esophageal stent in the context of an inoperable esophageal cancer using this technique over a 24-month period. The mean age was 70.4±9.6 years. Four (8.5%) patients underwent re-stenting due to proximal tumor overgrowth. No stent migration, perforation, tumor ingrowth or stent occlusion was reported. The mean patient survival was 146±26.5 days.
  
  
  CONCLUSIONS
  Esophageal stent insertion under endoscopic guidance with proximal tumor covering of 5 cm is effective and safe. No cases of stent migration and a low incidence of tumor overgrowth/undergrowth were observed with this technique.
authors.affiliation: CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Division of Thoracic Surgery, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Tahiri
authors.affiliation: CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Division of Thoracic Surgery, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ferraro
authors.affiliation: CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Division of Thoracic Surgery, University of Montreal, Montreal, Quebec, Canada.
authors.forename: André
authors.initials: A
authors.lastname: Duranceau
authors.affiliation: CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Division of Thoracic Surgery, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Melanie
authors.initials: M
authors.lastname: Berthiaume
authors.affiliation: CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Division of Thoracic Surgery, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Vicky
authors.initials: V
authors.lastname: Thiffault
authors.affiliation: CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Division of Thoracic Surgery, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
keywords: Esophageal stent; esophageal cancer; migration; self-expanding metallic stent; tumor ingrowth; tumor overgrowth