Usefulness of Double Esophageal Stent for Malignant Esophageal Stricture / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic self expandable metallic stent (SEMS) has become the palliative treatment of choice for inoperable malignant esophageal stricture. However, covered and uncovered stents carry limitations such as stent migration and tumor ingrowth, respectively. A double esophageal stent has been developed to overcome these problems. The aim of this study was to evaluate the usefulness of double esophageal stent (outer uncovered stent and inner covered stent) for palliation of malignant esophageal stricture. METHODS: Between February 2001 and November 2006, 32 patients with malignant esophageal stricture were treated with double esophageal stents. The patients were retrospectively assessed for the technical outcome, the clinical outcome and the complications of the process. RESULTS: Stent implantation was successful in all 32 patients (100%). The dysphasia score significantly improved from a mean of 3.22 to 1.63 (p<0.001) for all 32 patients. Eight patients had recurrent dysphagia due to stent overgrowth (6/32, 18%), stent migration (1/32, 3%) and tumor ingrowth (1/32, 3%). Symptomatic gastroesophageal reflux occurred in six patients (18%). Aspiration pneumonia occurred in two patients (6%). CONCLUSIONS: Double esophageal stent is effective for symptomatic relief of malignant esophageal stricture. It seems to reduce tumor ingrowth and stent migration, but it has limitations such as tumor overgrowth and GERD.

Usefulness of self-expandable metal stent for malignant esophageal stricuture / 대한내과학회지

BACKGROUND: Most patients with malignant esophageal stricture are surgically incurable at the time of presentation. The aim of this study was to determine the safety and efficacy of endoscopic expandable metal stent for palliation of dysphagia caused by malignant stricture. METHODS: From January 2000 to December 2001, thirty-two expandable metal stents (Nitis(R) Taewoong Med. Co. Korea, 6 uncovered, 12 covered, 14 double stents for antimigration, 18 mm diameter) were placed in 28 consecutive patients with dysphagia caused by malignancy. Dysphagia score, complications, reintervention, survival length after stent placement were evaluated. RESULTS: This study consisted of 23 men and 5 women. The patients were composed of 13 esophageal carcinomas, 11 gastro-esophageal junction cancers or cardiac cancers, 3 lung cancers, 1 breast cancer. Immediate improvement of dysphagia symptom was seen after initial stent placement in 27 patients (96%). Dysphagia score decreased from 3.0 (+/-0.51) to 1.06 (+/-0.77) after stent placement. There was one death due to hemorrhage after the procedure. There was no stent migration. Restenting was required in 4 cases due to tumor ingrowth (1/4) and overgrowth (3/4) and average interval to restenting was 95 days. Mean survival length was 109 days. CONCLUSION: Expandable metal stents offer excellent rapid palliation of malignant dysphagia. In a small subset of patients who received chemoradiation before stent placement, major complications such as bleeding, perforation, were observed.