Self-Expanding Metal Stents for Palliation of Malignant Esophageal Obstruction - A Pilot Study of Eight Patients

Abstract

We sought to determine whether the application of a self-expanding metal stent enables palliation of malignant dysphagia with minimal risk. The results of pilot studies from two centers are reported. We treated 8 inoperable patients with a 14 mm self-expanding metal stent (Wallstent). The stent was applied without general anesthesia under mild i.v. sedation. The procedure was successful in all cases. No side effects were noted. In one patient, tumor ingrowth through the meshes of the stent occurred. This patient was additionally treated with a percutaneous gastrostomy. One patient experienced tumor overgrowth of the proximal end, necessitating laser treatment. Three patients were still alive after three months. The mean number of cumulative endoscopic interventions per patient was 2.2 (SD: +/- 2; median 2). The mean observation time was 10.7 weeks +/- 2 (median 12). Dysphagia was graded from 0 (normal swallowing) to 4 (inability to swallow saliva). Dysphagia was significantly (p less than 0.0005) reduced from grade 3.1 (SD: +/- 0.35) to 0.5 (SD: +/- 0.5) immediately after stenting. 62.5% of the patients were able to manage a virtually normal diet (in one of these patients dysphagia recurred six weeks after stent placement due to tumor ingrowth). Six patients (75%) were able to ingest all necessary calories orally. The application of a 14 mm self-expanding metal stent in cases of inoperable malignant esophageal obstruction seems to offer safe and effective palliation of malignant dysphagia.

A pragmatic randomised controlled trial of the cost-effectiveness of palliative therapies for patients with inoperable oesophageal cancer

“…Early results were excellent and selfexpanding metal stents (SEMS) have supplanted conventional rigid tubes in many institutions as the palliative treatment of choice. [170][171][172] However, these results are now being questioned, as there is evidence to suggest that SEMS do not improve dysphagia to the extent expected and are associated with late complications and troublesome postinsertion pain. 173,174 They are also considerably more expensive (approximately £1000) than rigid tubes (approximately £100).…”

Definitive chemoradiotherapy for patients with malignant stricture due to T3 or T4 squamous cell carcinoma of the oesophagus

“…Chemotherapy, radiotherapy, laser therapy, and stent insertion have been reported to relieve symptoms. Recently, metallic stents have become popular in the palliative treatment of patients with dysphagia caused by oesophageal carcinoma (Song et al, 1991;Bethge et al, 1992;Fleischer et al, 1992;Kozarek et al, 1992;Schaer et al, 1992;Knyrim et al, 1993;May et al, 1995;Wengrower et al, 1998). These stents can be inserted on an outpatient basis and provide rapid relief of symptoms of dysphagia.…”

Esophageal Stenting in the Setting of Malignancy

“…They may provide instant dysphagia relief in up to 96% of patients while improving dysphagia scores by 1-2 grades. Despite the various types of stents available there is no apparent superiority among different stents with regards of dysphagia relief [21, 25–30]. In a prospective randomized controlled trial, Sabharwal and colleagues compared the rate of early and late complications (perforation, migration, severe gastroesophageal reflux, hematemesis, and reobstruction due to tumor overgrowth) in 53 patients diagnosed with inoperable lower third esophageal carcinoma randomized to receive either a flamingo covered wallstent (Boston Scientific Inc., Watertown, Mass, USA) or an Ultraflex covered stent (Boston Scientific Inc.) for palliation.…”