Palliative treatment of malignant esophageal stenosis: the role of self-expanding stent endoscopic implantation

Abstract

Endoscopic tube implantations were carried out in 40 patients with malignant stenosis of the esophagus and gastric cardia using self-expanding metallic stents. The indications for endoscopic intubation were the advanced stage of the tumor in 27 cases and risk factors that made resection inadvisable in 13 cases. In three patients, it proved impossible to implant a stent endoscopically because we were not able to pass the guide wire through the stenosis, whereas correct stent placement was achieved in 37 cases. Functional results were good in 33 patients, but four patients did not show any improvement of symptoms. Complications occurred in nine patients (24.3%): two bleedings, three neoplastic obstructions, one food obstruction, and three distal dislodgements of the prosthesis were observed, but could be readily corrected. No deaths occurred. The median survival time was 151 days (range 25±545 days). This study suggests that endoscopic placement of metallic self-expanding stents is safe and is to be preferred to plastic stents for easier implantation and lower morbidity.

Neoplasia avançada de esôfago: diagnóstico ainda muito tardio

“…Vários modelos de próteses, inicialmente plásticas e rígidas, atualmente metálicas autoexpansíveis foram desenvolvidas (7,8,14,19,22,31) . As PMAE são de inserção mais simples e menos traumáticas, quando comparadas aos dispositivos plásticos, com menores índices de complicações e mortalidade (3,5,14,16,23,28) . As próteses plásticas levam ao alívio da disfagia em número satisfatório de pacientes.…”

“…O procedimento pode ser realizado com sucesso em até 90% dos pacientes, sendo de fácil inserção, associada a baixos índices de morbimortalidade (3,14,17,23,28,29) . O fechamento das fístulas esôfago-respiratórias é alcançado em 70% a 100% (3,14,23) . A incidência de complicações tardias associadas a PMAE varia de 20% a 40%, incluindo dor torácica, migração, fi stulização e crescimento tumoral (14,28) .…”

“…Neste momento a maioria dos pacientes apresenta doença localmente avançada ou metastática (5,8,10,12,17,19,23,29,31) . A sobrevida média é de 4 a 6 meses, independente da terapêutica aplicada (5,8,11,23,24) .…”

“…A sobrevida média é de 4 a 6 meses, independente da terapêutica aplicada (5,8,11,23,24) . A sobrevida em 5 anos é de apenas 10% a 15% (5,10,31) .…”

Evolution of Surgical Resection for Duodenal Duplication Cyst

“…2 These entities are even less common in adults, where treatment traditionally involves surgical resection when symptomatic. [3][4][5] Duodenal duplication resection can be challenging, even for the most experienced surgeons because of the anatomic proximity of these cysts to the ampulla.…”