Self-expanding plastic stents for inoperable malignant strictures of the cervical esophagus

Abstract

Dysphagia and respiratory complications are the major problems in patients suffering from malignant strictures of the cervical esophagus. In inoperable cases, interventional palliation is the cornerstone of treatment. The aim of this study was to evaluate the use of self-expanding plastic stents (SEPS) in this group of patients. In a retrospective study, 23 patients suffering from various malignant obstructive diseases of the cervical esophagus, including squamous cell carcinoma (n = 10), laryngeal cancer (n = 7), lung cancer with esophageal invasion (n = 5), and metastatic breast cancer (n = 1), underwent SEPS placement, under endoscopic and fluoroscopic guidance. Tracheoesophageal fistula was documented in five patients. Technical success rate, improvement of dysphagia grade, and stent-related complications were evaluated after stent placement. Stent insertion was successfully achieved in all cases, namely in 20 patients at the first stent placement attempt and in three patients after a second attempt. Dysphagia grade was notably improved after 24 h. In two cases, major complications occurred. These were successfully treated without the need of stent extraction. Barium swallowing studies demonstrated complete sealing of all fistulas. Foreign-body sensation that gradually disappeared within the first week after stent placement was observed in eight patients. Recurrence of dysphagia occurred in three patients, due to hyperplastic tissue proliferation (n = 2) and tumor overgrowth (n = 1). Late migration of the stent was detected in one case after 67 days. SEPS placement is an effective and safe palliative treatment for malignant strictures of the cervical esophagus. Main advantages include easy retrievability and reduced rates of reinterventions.

Polymeric nanofiber coated esophageal stent for sustained delivery of an anticancer drug

“…An esophageal stent is accepted in clinical use to mechanically open an esophagus clogged by cancerous tissues, allowing feeding capacity as well as improving a life quality of the patients. 5,6 Various types of esophageal stents have been developed for this purpose, 5-8 many of which, however, still pose problems of re-occlusion due to rapid growth of tumors around the stent. This reduces the effective lifespan of the stent, needing multiple times of major surgeries for stent replacement.…”

“…5,7 However, for almost all cases, the esophageal stents suffer from re-occlusion due to rapid growth of tumors around the stent to shorten the effective lifespan of the treatment, hence multiple of major surgeries for stent replacement. 5,6 In this sense, local and sustained delivery of an anti-cancer agent would be advantageous to suppress the tumor growth around the esophageal stent. In such systems, the drug would be released specifically towards the cancerous tissues in the esophagus, possibly achieving effective drug bioavailability around a stent for a prolonged period of time without unnecessarily high systemic drug exposure.…”

“…5,6 These stents are designed to possess good mechanical flexibility for ease of insertion and elimination of excessive esophagus dilation. 5,7 However, for almost all cases, the esophageal stents suffer from re-occlusion due to rapid growth of tumors around the stent to shorten the effective lifespan of the treatment, hence multiple of major surgeries for stent replacement.…”

“…Various types of esophageal stents, made of metal, plastic or bioabsorbable polymer, have been technically evolved [5][6][7][8] and many of them are already in clinical use to relieve dysphasia. 5,6 These stents are designed to possess good mechanical flexibility for ease of insertion and elimination of excessive esophagus dilation.…”

Pilot Data on the Endoscopic Placement of Covered Metal Stents to Treat Gastrojejunal Leaks in a Porcine Model

“…Stents in the upper GI tract are currently mostly used for malignant obstruction or to treat complications after esophageal surgery [8][9][10][11][12][13]. Treatment of chronic fistulas at the gastrojejunal anastomosis has been described in case reports and small retrospective series [14,15].…”