Fluoroscopically guided insertion of self-expandable metal esophageal stents for palliative treatment of patients with malignant stenosis of esophagus and cardia: comparison of uncovered and covered stent types

Abstract

The aim of this retrospective study was to present and compare the results of using two different types of esophageal self-expanding stents (uncovered and covered) for palliative treatment of patients with inoperable malignant stenosis of the esophagus and cardia. Over a period of 8 years, 152 patients underwent fluoroscopically guided insertion of metal esophageal stents. We inserted uncovered esophageal nitinol Strecker stents in 54 patients (group I) and covered esophageal Ultraflex stents in the remaining 98 patients (group II). The stent insertion procedure was successively performed in all patients. Closure of esophageal fistula by covered stents was achieved in 8/8 patients. Mean dysphagia score was significantly decreased in both patient groups at 4 weeks follow-up: from 2.73 before stent insertion to 0.15 in group I, and from 2.67 to 0.05 in group II (on 0-4 scale). Eighty-eight per cent of patients with covered stents and 54% with uncovered type were free of symptoms during follow-up. Complications occurring during follow-up and their comparative frequency in the two groups of patients were as follows (group I: group II%): stent migration (0 : 10%); tumor or granulation tissue ingrowth (100 : 53%); overgrowth at the ends of stents (17 : 30%); restenosis causing recurrent dysphagia (37 : 8%); and appearance of esophageal fistulas (8 : 6%). In conclusion, fluoroscopically guided insertion of self-expandable esophageal stents is a safe and comfortable method of palliation for patients suffering with malignant dysphagia. In selection of a stent, covered types should be given priority for prevention of restenosis.

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

“…Comparative studies of various types of self-expanding oesophageal stents reported similar rates of efficacy and complications. [175][176][177][178][179][180] Immediate haemorrhage rates are low, but consideration should be given to delayed severe haemorrhage, and this is likely to be a particular risk in patients on APA or anticoagulant therapy.…”

Esophageal Stent Migration Into Trachea

“…The incidence of post-stenting TE fi stula has not been shown to differ between types of stents [2]. In patients in whom TE fi stula occurs, survival from the diagnosis of TE fi stula rarely exceed 30 days [2].…”

“…The incidence of post-stenting TE fi stula has not been shown to differ between types of stents [2]. In patients in whom TE fi stula occurs, survival from the diagnosis of TE fi stula rarely exceed 30 days [2]. Taking the risk of stentrelated complications into consideration, further investigation is needed to identify the risk factors for stent-related TE fi stula to properly select candidates of esophageal stenting for malignant stenosis.…”

“…During the procedure, stenosis was encountered at 17 cm from the incisor; the endoscope (GIF Q240, Olympus, Tokyo, Japan) with an outer diameter of 10.2 mm could not be passed. Using a wire-guided catheter technique and concurrent endoscopic and fl uoroscopic monitoring [2], a 12 cm long, 28/23 mm wide self-expandable metal stent (Ultrafl ex, Boston Scientifi c, Natick, MA, USA) was implanted. Post-procedure day 7, due to postprandial cough after liquid intake, feeding gastrostomy was arranged on post-procedure day 11.…”

“…Tracheoesophageal fi stula (TE fi stula) is a known comorbidity of esophageal malignancy as the disease progresses with an incidence of 5% [1,2]. Esophageal stenting has been used to manage TE fi stula [3,4].…”