Esophageal Stenting in the Setting of Malignancy

Abstract

Esophageal cancer is often diagnosed at an advanced stage, with many patients found to have locoregional or metastatic disease at time of diagnosis. Because of this, cure may be unlikely, leading treatment efforts to focus more on symptom palliation and improving patient quality of life. The majority of patients with advanced disease suffer from some degree of dysphagia. Palliative efforts are therefore directed at relieving dysphagia, allowing patients to manage their oropharyngeal secretions, reduce aspiration risk, and maintain caloric intake orally. A variety of endoscopic treatment modalities have been utilized with these objectives in mind, with options determined by the location and size of the tumor, as well as the patient's expected prognosis. In this article, we review the use of endoscopically-placed stents for palliation in patients with advanced esophageal cancer. We discuss the history of stent use in such cases, as well as more recent developments in stent technology. We give an overview of some of the more commonly used stents in practice, discuss the technique of insertion, and survey the short- and long-term outcomes of stent placement.

Paclitaxel or 5-fluorouracil/esophageal stent combinations as a novel approach for the treatment of esophageal cancer

“…Esophageal cancer often causes malignant esophageal stricture or even obstruction, which may lead to dysphagia and aphagosis, followed by severe malnutrition and malignant constitution [16]. These symptoms not only lower the quality of life tremendously in these patients, but the poor prognosis of esophageal cancer also means that surgical resection is not suitable for the majority of patients (>50%) because of poor patient condition.…”

Fluoroscopically-guided palliative stenting for the management of malignant oesophageal obstruction: A five year experience

“…[7][8][9][10][11]15 Our study has a stent re-insertion rate of 9%, which is at the lower end of the reported range of 7% to 26%. 6,9,13,14,16,17 Post-stent median survival is dismal, but unfortunately within the expected range for patients undergoing palliative treatment for oesophageal cancer. We believe this report demonstrates that good outcomes can be achieved with fluoroscopic-guided stent insertion by experienced radiologists.…”

“…Further study is required to show whether covered or uncovered stents are preferable. 17,19 Our unit policy has been to use double layer stents, with an uncovered outer layer, as these have low displacement rates (0% in this series) and good technical outcomes, in terms of stent position and immediate postprocedure patency. 5 Thermal and ablative techniques, such as APC, have also been used but are not as widely available.…”

“…There have been key review articles and a Cochrane metaanalysis discussing the best treatment options for oesophageal obstruction. 13,17,18 SEMS are established as superior treatments to plastic tubes. Further study is required to show whether covered or uncovered stents are preferable.…”

In Vitro and In Vivo Assessment of Docetaxel Formulation Developed for Esophageal Stents

“…Of these, partially covered esophageal stents are preferred for palliation (3). But in the case of covered stents, 4-18% of cases experience tumor overgrowth at the ends of the stent (4). Docetaxel (DTX) is an anticancer drug used in the treatment of EC but systemic use of DTX is associated with neurotoxicity, musculoskeletal toxicity, and neutropenia.…”