Abstract
Background: Fewer complications are encountered with the use of self-expanding metal stents compared
with semirigid prostheses in the palliation of patients with malignant esophagogastric
obstructions. Metal stents can also be used to treat patients with complicated and/or
recurrent esophagogastric carcinoma. Methods: Covered metal stents were placed in 57 patients for the following reasons: esophagorespiratory
fistula (n = 16), recurrent carcinoma in a gastric tube interposition (n = 21), recurrent
carcinoma after partial (n = 4) or total (n = 6) gastrectomy, or a carcinoma near
the upper esophageal sphincter (n = 10). Results: The procedure was technically successful in 55 of 57 (96%) patients. Dysphagia score
improved from a mean of 3.6 to 1.6 (p < 0.001). Major complications occurred in 13 (23%) patients. In all cases, esophagorespiratory
fistulas were occluded. Tumor recurred in 5 of 16 patients with a fistula, 8 of 21
patients after gastric tube interposition, 3 of 10 patients after gastrectomy, and
2 of 10 patients with a tumor immediately distal to the upper esophageal sphincter.
Median survival was 61 days. Prior radiation, chemotherapy, or both increased the
risk of specific stent-related complications in relation to the (neo)esophagus (6
of 16 [38%] versus 4 of 41 [10%]: odds ratio, 5.5: 95% CI [1.3, 24], p = 0.018). Conclusions: Self-expanding metal stents are effective and relatively safe for palliation of patients
with malignancy and dysphagia caused by fistula formation, postoperative recurrence,
and tumors near the upper esophageal sphincter. Placement should be considered at
an early stage in these conditions. (Gastrointest Endosc 2001;54:579-86.)
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Article info
Publication history
Accepted:
July 13,
2001
Received in revised form:
August 30,
2000
Received:
June 12,
2000
Footnotes
☆Reprint requests: Peter D. Siersema, MD, Department of Gastroenterology and Hepatology, University Hospital Rotterdam—Dijkzigt, PO Box 2040, Rotterdam, 3000 CA, Netherlands.
Identification
Copyright
© 2001 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
