Safety and Efficacy of Self-Expandable Metallic Stent Placement Using Low Radial Force Stent for Malignant Dysphagia after Radiotherapy

Abstract

<b><i>Introduction:</i></b> We aimed to investigate the safety and efficacy of self-expandable metallic stent (SEMS) placement in patients with prior radiotherapy (RT) using the Niti-S stent, which is characterized by low radial force, in comparison to patients without prior RT. <b><i>Methods:</i></b> A consecutive series of 83 patients who were treated by SEMS placement using Niti-S stent for severe malignant esophageal obstruction or fistula were enrolled. The adverse event rates and efficacy were retrospectively compared between patients with/without prior RT before SEMS placement (RT group [<i>n</i> = 32] versus non-RT group [<i>n</i> = 51]). <b><i>Results:</i></b> The incidence rate of major adverse events in the RT group was 6.3% and was not significantly different from that in the non-RT group (5.9%, <i>p</i> = 0.95). Among the RT group, 84.4% were able to resume oral intake within a median of 2 days. Among the patients with fistula, 78.6% could resume oral intake and survive for 73 days after SEMS placement. Cox proportional hazard regression analysis identified significant factors affecting overall survival to be prior RT (hazard ratio [HR]: 1.96), low performance status (HR: 3.87), and subsequent anticancer treatment after SEMS placement (HR: 0.41). However, compared to the non-RT group, the RT group had received longer duration of anticancer treatment before SEMS placement and a lower rate of subsequent anticancer treatment after SEMS placement. <b><i>Conclusions:</i></b> With the Niti-S stent, the incidence of major adverse events was sufficiently low even for patients after RT. SEMS with low radial force would be an effective palliative treatment option for patients, regardless of prior RT.

Fixation of an esophageal stent using a novel re‐openable endoclip for a tracheoesophageal fistula

“…Esophageal stenting is typically indicated for unresectable malignant esophageal stenosis, severe stenosis following radiotherapy, and tracheoesophageal fistulas. 1,2,[6][7][8] Although the incidence of stent migration in cases of severe stenosis is reported to be relatively rare, ranging from approximately 0% to 3.6%, [6][7][8] tracheoesophageal fistulas are associated with a higher rate of stent migration than severe stenosis conditions. 2 This makes the management of stent migration critical, as its occurrence can cause serious complications such as bleeding and perforation.…”

“…Patients with esophageal cancer with tracheoesophageal fistula may have esophageal stenting as a palliative treatment option, but complications include stent migration. Esophageal stenting is typically indicated for unresectable malignant esophageal stenosis, severe stenosis following radiotherapy, and tracheoesophageal fistulas 1,2,6–8 . Although the incidence of stent migration in cases of severe stenosis is reported to be relatively rare, ranging from approximately 0% to 3.6%, 6–8 tracheoesophageal fistulas are associated with a higher rate of stent migration than severe stenosis conditions 2 .…”

Efficacy and Safety of Self-Expandable Metallic Stent Placement for Malignant Esophageal Fistula

“…The stent length was chosen so that it covered at least 2 cm beyond each tumor edge, particularly on the oral side, covering the fistula in the center of the stent. All SEMS placements were performed under fluoroscopic guidance, as previously described [ 23 ]. All patients were sedated with midazolam and pethidine hydrochloride during the procedure.…”

Medical radiation exposure during gastrointestinal enteral metallic stent placement: Post hoc analysis of the REX‐GI study

“…Enteral metallic stent placement for malignant gastrointestinal obstruction has been widely used in recent years. Since the development of esophageal stents for esophageal obstruction, gastroduodenal stents and colonic stents that can be implanted through an endoscope have become available in daily practice 7–13 . The treatment outcomes of cancers that cause gastrointestinal stenosis are also continuously improving, and the frequency of malignant gastrointestinal stenosis is increasing as patient survival is prolonged.…”

“…Since the development of esophageal stents for esophageal obstruction, gastroduodenal stents and colonic stents that can be implanted through an endoscope have become available in daily practice. 7 , 8 , 9 , 10 , 11 , 12 , 13 The treatment outcomes of cancers that cause gastrointestinal stenosis are also continuously improving, and the frequency of malignant gastrointestinal stenosis is increasing as patient survival is prolonged. Enteral metallic stent placement is performed in various organs depending on the disease site.…”