Endoscopic palliative treatment of esophageal and cardial cancer: A new antireflux prosthesis a study of 40 cases

Abstract

Forty patients with malignant cardioesophageal obstruction were treated by fiberoptic intubation. Their ages ranged from 38 to 84 years. Eight patients had bronchoesophageal fistula, 9 had tumor relapse after radiation therapy, and 5 had hiatal hernia. In 7 with severe or total stenosis, diathermic resection was used with no morbidity or mortality. Complications were hemorrhage, 2; regurgitation, 2; atelectasis, 1; tube migration, 1; and bronchoesophageal fistula, 1, for a total of 17.5%. The procedure mortality was 2.5%. Actuarial survival time after intubation was 37.5% at 12 months. It was demonstrated that a new antireflux prosthesis, designed for endoscopic insertion, diminished morbidity and avoids mortality due to regurgitation; we would therefore recommend to be used in patients not otherwise amenable to surgery or radiotherapy, with cancer of the cardia, lower esophagus or lesions beyond 24 mm from the incisors associated with hiatal hernia.

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

“…Indeed, gastroesophageal reflux was observed primarily in patients with tumor of the lower esophagus/GEJ (18 of 21 patients with gastroesophageal reflux). Symptoms of gastroesophageal reflux are reported to occur in 5-15% of patients with standard open stents [19,23], whereas they affect up to one-third of patients who have received a stent for a malignant stricture of the GEJ, especially when they are in the supine position [22,35]. It is our policy to prescribe proton pump inhibitors for patients with SEMS placement for esophagogastric tumors, and we advise patients to sleep in an upright position and to avoid having late-night meals.…”

Oesophageal stenting

“…However, in this situation the lower oesophageal sphincter (LOS) is disrupted, effectively creating a "common chamber" between the stomach and oesophagus, allowing free reflux to occur, often requiring medical therapy [119][120][121][122]. In an attempt to overcome this, stents have been created with antirefiux mechanisms [119,[123][124][125][126].…”

An antireflux stent versus conventional stents for palliation of distal esophageal or cardia cancer: a randomized clinical study

“…However, stent treatment of patients with a malignant tumor at or near the esophagogastric junction is more complex than management of more proximal tumors because placement of a standard open stent across this junction may result in severe gastroesophageal reflux and pulmonary aspiration [5]. Severe heartburn and respiratory symptoms are reported to occur in about one-third of patients who have received a stent for a malignant stricture at this site [12]. This seems to be particularly problematic when patients are in the supine position, which may be of special relevance at night.…”

“…Nunes et al [9] and Valbuena [12] attached latex sleeves to rigid plastic esophageal stents, and Dua et al [3] designed a modified self-expanding esophageal Z-stent with a valve to prevent reflux. This latter valve has the shape of a ''wind sock,'' and preliminary reports have suggested that it can prevent reflux without interfering with physiologic flow [3].…”