Prótesis Choostent como método de paliación de la disfagia secundaria a patología maligna

Abstract

Use of Choostent prosthetic device for palliation of dysphagia secondary to esophageal cancer Background: Esophageal cancer causes disabling dysphagia and swallowing problems. Aim: To prospectively analyze the outcome of the insertion of a covered self-expanding metallic Choostent type prosthesis as a method of palliation of dysphagia, esophageal fistula or leak secondary to malignant disease of the esophagus or cardia. Material and Methods: A total of 30 consecutive patients aged 75 ± 8.8 years (63% males) with malignant disease of the esophagus or cardia were studied. Results: In 27 patients (90%) the stenosis was located in the esophagus, in two (6.7%) at the gastroesophageal junction and in one (3.3%) at the esophago -jejunal anastomosis due to tumor recurrence. In 24 cases (80%), the indication of the prosthesis was dysphagia, in three (10%) the presence of a tracheo-esophageal fistula and in the remaining three (10%), the suspicion of a perforation. Patients were followed until death. The prosthesis was inserted without incidents in 29 patients (96.6%). One patient had a pneumomediastinum, which evolved favorably. Dysphagia subsided in all patients. Early evolution was satisfactory in 12 patients (66.7%). The most common early complication was a transient chest pain in 3 cases (10%). Four patients (13.3%) died within 30 days post procedure. Of the remaining 26 patients, 14 (53.8%) had late complications (recurrence of dysphagia in 42% and hemorrhage in 11%). The mean interval between stent insertion and death was 169 ± 142.5 days. Conclusions: The Choostent esophageal prosthesis improves dysphagia immediately and safely. However, its use is associated with a high rate of late complications, directly related to prosthetic dysfunction.

Tratamiento Paliativo Del Cáncer Esofágico Y De La Unión Gastro-Esofágica Mediante Colocación De Prótesis Transtumoral Por Vía Endoscópica

“…Las complicaciones tardías más frecuentes incluyen el desplazamiento (12%) y la obstrucción de la prótesis por alimentos impactados o por crecimiento de la neoplasia (3,4%-10%) [22][23][24][25][26] . Otras compli-caciones son la incapacidad de auto expansión o complicaciones respiratorias y compresión de la vía aérea que se presentan en un grado variable según el modelo de prótesis 17 .…”

“…Otros autores opinan que esta complicación no debiera ocurrir, porque si bien hay disminución de la estenosis tumoral, se produce edema, luego fibrosis y aperistalsis, que mantiene la prótesis en esta posición. La media de permeabilidad de las prótesis publicadas en la literatura, es de aproximadamente 6 meses, similar a nuestros resultados, la que es posible prolongar con quimio-radioterapia, pero tiene el agravante de favorecer la migración, debido a la disminución del tamaño o grado de estenosis tumoral 23,[26][27][28][29][30][31] .…”

Iatrogenic Oesophageal Perforations in Neoplastic Lesions: Management with Covered Self-Expanding Prostheses

“…Endoscopic dilation of the oesophagus is a long-established technique for treating benign strictures of this organ [4]. It has also been used to manage dysphagia in unresectable malignant lesions as a sole palliative measure [5] or as a step before endoprosthesis implantation [6].…”

“…Oesophageal prostheses, initially limited to palliation of dysphagia in malig-Open Journal of Gastroenterology nant neoplasia [6] [14], are currently being used successfully to treat, among others, anastomotic leaks [15], benign strictures [16], spontaneous perforations [17], tracheoesophageal fistulas [18], and oesophageal variceal haemorrhage [19].…”

Expandable Metallic Stents in Esophageal: Experience in the National Center for Minimal Access Surgery

“…5 De manera general las indicaciones propuesta por la Sociedad Mundial de Gastroenterología y Endoscopia se resumen en enfermedades concomitantes fuera del alcance quirúrgico, edad avanzada, dilataciones inefectivas o complicadas, estenosis malignas, benignas, extrínsecas, largas, obstructivas, de crecimiento rápido, posradioquimioterapia, fístulas esófagotraqueales y recurrencia tumoral. [6][7][8][9][10] El objetivo de este reporte es mostrar los resultados alcanzados por nuestro grupo en la colocacion de endoprótesis metalicas autoexpandibles (SEMS, Niti-S-stent; Taewoong Medical, Seoul, Korea) en pacientes con estenosis malignas o benignas del tractos digestivo superior remitidos de diferentes partes del país.…”