Clinical application of metallic stents in treatment of esophageal carcinoma

Yang, Huajun

doi:10.3748/wjg.v11.i3.451

Cited by 9 publications

(8 citation statements)

References 18 publications

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“…Our review confirms that SEMS provide a rapid, significant improvement in dysphagia in this cohort of patients ( P < 0.0001, Wilcoxon signed ranks). This is in agreement with a number of previous studies, providing experience with a multitude of different SEMS 10–15 . The length of hospital stay following stent insertion was longer than has been suggested by Homs et al ., 1 although, in a comparison of plastic prothesis and SEMS insertion, Knyrim et al .…”

Section: Discussionsupporting

confidence: 92%

“…have detailed a 78% 6‐month survival in 66 patients with malignant esophageal obstruction. In this cohort, they have reported an 11% two‐year survival 14 . A possible explanation for the brevity of survival may well be our approach to timing of SEMS insertion.…”

Section: Discussionmentioning

confidence: 99%

“…This is in agreement with a number of previous studies, providing experience with a multitude of different SEMS. [10][11][12][13][14][15] The length of hospital stay following stent insertion was longer than has been suggested by Homs et al, 1 although, in a comparison of plastic prothesis and SEMS insertion, Knyrim et al recorded a mean stay in the SEMS group of 5.4 days. 16 In addition, in a study comparing SEMS insertion with singledose brachytherapy, Polinder et al reported a total hospital stay in the SEMS group of 11.5 days.…”

Section: Discussionmentioning

confidence: 99%

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Ten-year experience of esophageal self-expanding metal stent insertion at a single institution

Stewart

Balamurugan

Everitt³

et al. 2012

Dis Esophagus

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Palliation of malignant dysphagia can be achieved using self-expanding metal stents (SEMS). This study was conceived to confirm that the insertion of SEMS improved patient symptoms without serious complications and to allow comparison with recent national data. Retrospective case note review of all patients receiving SEMS over a 10-year period between March 1999 and February 2009 was used in this study. There were 138 consecutive patients (50 female), median age of 75 (range 46-90) years, 122 (88.5%) had primary malignant disease of the esophagus or gastroesophageal junction. In total, 250 endoscopic examinations were carried out, with 200 interventional procedures, including the insertion of 156 SEMS. Before stenting, 74.2% of patients had a dysphagia score of 2-3. Following stent insertion, dysphagia scores improved to 0-1 in 90.3% of patients (P < 0.0001, Wilcoxon signed ranks). No complications were encountered in 61 (44%) patients. Chest pain was the most frequent difficulty, encountered in 50 (36%) patients. Tumor overgrowth occurred in 17 (12.3%) patients and food bolus obstruction was seen in 7% of patients. There were no esophageal perforations attributable to SEMS insertion. Overall 30-day mortality for those with esophago-gastric malignancy was 11.6% (16 patients), although the SEMS-related mortality was 2.2% (3 patients). Median survival from SEMS insertion was 3 (IQR 1.5-7) months. Patients requiring re-intervention for tumor overgrowth had a significantly longer median survival of 9.2 months (P= 0.001, log rank). SEMS were well tolerated with overall mortality and complication rates comparable to national data. For the longer survivors, re-intervention for recurrent dysphagia was not unusual.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ten-year experience of esophageal self-expanding metal stent insertion at a single institution

Stewart

Balamurugan

Everitt³

et al. 2012

Dis Esophagus

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“…With the use of self‐expandable metallic stents, relief of dysphagia appears just after the process and lasts a long time 14 . It has been shown that self‐expandable metallic stents are superior to plastic stents in their promotion of general quality of life 15 .…”

Section: Discussionmentioning

confidence: 99%

The use of self-expandable metallic stents for palliative treatment of inoperable esophageal cancer

Eroğlu

Türkyılmaz

Subaşı

et al. 2010

Diseases of the Esophagus

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Most patients with esophageal carcinoma present in the advanced stage die from tumor invasion and widespread metastases. Because radical regimens are not appropriate for the majority of patients, and their expected survivals are as short as to be measured by months, the main aim of therapy is palliation with minimum morbidity and mortality. Among the palliative modalities are surgery, external radiotherapy or brachytherapy, dilatation, laser, photodynamic therapy, bipolar electrocoagulation tumor probe, and chemical ablation. The placement of self-expandable metallic stents is another method that improves dysphagia for these patients. In this study, the aim was to evaluate retrospectively the effectiveness of metallic stents deployed because of inoperable malignant esophageal stenosis and esophagotracheal fistulas. The results of 170 patients with 202 stents administered because of inoperable malignant esophageal stenosis and esophagorespiratory fistula between January 2000 and October 2008 at the Ataturk University, Department of Thoracic Surgery, were investigated. Despite epidemiological and clinical data, information regarding relief of dysphagia and quality of life were also examined. One hundred seventy patients with stents were between 28 and 91 years old (mean age 63.7 years+/-11.4 years). Ninety-seven were male and 73 were female. Stent indications were advanced tumors with distant metastasis (82 cases, 48.2%), unresectable tumors (51 cases, 30%), patients who cannot tolerate surgery or chemoradiotherapy (18 cases, 10.5%), local recurrence after primary therapy (1 case, 0.5%), esophagorespiratory fistulas from tumor or therapy (14 cases, 8.2%), and refusal of surgery (4 cases, 2.3%). Dysphagia scores evaluated by a modified Takita's grading system improved from 3.4 before the procedure to 2.6 afterward. The overall complication rate without chest pain was 31.7% (occurring in 64 cases). Mean survival was 177.7 days+/-59.3 days (2-993 days). Quality-of-life scores (The European Organization of Research and Treatment of Cancer QLQ C30) improved from 73+/-10.3 (57-85) to 112+/-12.6 (90-125). In therapy of malignant esophageal obstructions, metallic stents provide a significant improvement in dysphagia and require less frequent re-intervention according to other methods of dysphagia palliation such as dilatation, laser, and photodynamic therapy, nearly completely relieve esophagotracheal fistulas and improve quality of life to an important degree.

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“…It is believed that after this treatment, vasculitis and ischemia of the esophageal tissue occurs, and that the pressure exerted by the stent can produce local necrosis which can increase the rate of complications, such as migration of the stent, perforation, hemorrhage and the fistula formation 3,34,37,41 . On the other hand, stent placement with adjuvant cytoreductive therapy can ensure earlier oral food ingestion, prevent stenosis secondary to the radioactive therapy, and allow RT/CT therapy in patients with tracheo-esophageal fistula.…”

Section: Discussionmentioning

confidence: 99%

Assesment of placement of the esophageal self-expandable metallic stent in esophageal cancer in patients with or without citorreduction therapy

Kamiyama

Sakai

Moura

et al. 2007

ABCD, arq. bras. cir. dig.

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BACKGROUND: Placement of self-expanding metallic esophageal stent in patients with advanced esophageal cancer offers excellent palliation of dysphagia and tracheo-esophageal fistulas. However, the safety of stent in patients undergoing radio and/or chemotherapy is controversial, in terms of the greater risk of complications in cases where these two treatments are used in conjunction. AIM: To assess the use of stent in patients with advanced cancer of the mid-thoracic esophagus, by comparing patients undergoing cytoreductive therapy with patients who have not undergone this treatment, in relation to improvement in the dysphagia, rate of complications, period of effectiveness and survival time. METHODS: Fifty seven patients were evaluated retrospectively (16 women and 41 men, with an average age 62 years) with advanced squamous cell carcinoma of the mid-thoracic esophagus who underwent placement of the Ultraflex™ self-expandable metallic coated stent, at the Gastrointestinal Endoscopy Unit of São Paulo University Medical School between October 1988 and October 2004. Out of the 57 patients, 24 patients received adjuvant cytoreductive therapy, and 33 patients were only treated with the stent placement. RESULTS: After stent placement, there was improvement in dysphagia in both groups; there were no differences in the rate of complications, such as migration, pain, fistula, obstruction and compression of the airways; the period of effectiveness was significantly higher in the group submitted to cytoreductive therapy (average 123 days compared to 63 days), as was the survival time (average of 210 days, compared with 120 days). CONCLUSIONS: Improvement in dysphagia was statistically significant in both groups, irrespective of whether the patient had undergone adjuvant cytoreductive therapy; there were no differences in the rate of complications between the two groups and both the period of effectiveness of the stent treatment and the survival time were higher in the group with adjuvant cytoreductive therapy.

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Clinical application of metallic stents in treatment of esophageal carcinoma

Cited by 9 publications

References 18 publications

Ten-year experience of esophageal self-expanding metal stent insertion at a single institution

Ten-year experience of esophageal self-expanding metal stent insertion at a single institution

The use of self-expandable metallic stents for palliative treatment of inoperable esophageal cancer

Assesment of placement of the esophageal self-expandable metallic stent in esophageal cancer in patients with or without citorreduction therapy

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