Expansile metal stents are a safe and cost-effective alternative to conventional plastic endoprostheses in the treatment of esophageal obstruction due to inoperable cancer.

Membrane-covered stents have significantly better palliation than conventional bare metal stents because of decreased rates of tumor ingrowth that necessitate endoscopic reintervention for dysphagia.

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Patients with intrinsic lesions have better palliation of dysphagia than those with extrinsic lesions. Future studies with other study designs will need to consider this.

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We sought to determine the efficacy of metal stents in the palliation of malignant upper gastrointestinal stenoses. Six patients with inoperable malignant obstruction of the upper gastrointestinal tract, intractable nausea and vomiting, and an inability to maintain an oral intake were studied. A metal stent was inserted under endoscopic control and deployed in the stenosis. Stents were successfully deployed in all patients, and there were no immediate complications. All patients were able to eat after the procedure and parenteral nutrition was discontinued in all. Mean survival was 23 +/- 8.6 days. We conclude that metal stents represent a promising approach to the management of selected patients with malignant upper gastrointestinal stenoses and that their use warrants further study.