Self - Expanding EsophaCoilTM Esophageal Prosthesis for Malignant Esophageal Stenosis / 대한소화기내시경학회지

Endoscopic endoprosthesis is well established as a cheap, fast and durable procedure for palliation of malignant dysphagia. But the placement of conventional endoprosthesis is difficult and is associated with significant complications such as hemorrhage, perforation and dysfunction of the prosthesis. Recently, self -expand- able metal prosthesis have also been utilized for malignant esophageal stenosis, and palliation of this modality seems to be more effective than other modalities. However the main problems with these metal stents are tumor ingrowth leading to reobstruction, migration, and eophageal trauma by the distal, hard skirt of the stent. EsophaCoil stent is a simple coil with close loops made from a single flat wire of nickel titanium alloy. The radial force of this material is much stronger than stainless steel, expansion time is faster and the stent is able to dilate even extremely resistant strictures. This new metalic stent seems to have several advantages over the current commnerically available ones. We report our experiences with this EsophaCoil stent and review of literature.

Self - expanding Wallstent for Palliative Treatment of Malignant Esophageal Stenosis / 대한소화기내시경학회지

The main objective of palliative treatment of malignant esophageal stenosis is rapid restoration of passage of fluid and solids. Endoscopic intubation with plastic endoprosthesis may lead to prompt relief of dysphagia and is a effective procedure for the palliative treatment of malignant esophageal stenosis. However, the insertion procedure, which necessitates prior dilatation, is traumatic and associated with considerable risk for perforation and bleeding. Tumor overgrowth, stent migration and stent blockage are frequent complications. Recently, self expanding metal stents woven in the form of tubular mesh made from surgical grade stainless steel alloy filaments(Wallstent), have been developed to offer possible advatage over conventional plastic tubes. The small diameter of introducer system carrying the compressed stent(18Fr) allows a relatively easy insertion procedure that dose not require prior dilatation. This stent is pliable. self-expanding and flexible in the longitudinal axis. We experienced a case of a 74-year-old male with malignant esophageal stenosis in whom self-expanding Wallstent was implanted with successful oral nutrition and much improvement of dysphagia.

Self - Expanding UltraflexTM Esophageal Prosthesis of Malignant Esophageal Stenosis / 대한소화기내시경학회지

Endoscopic intubation is well established as a cheap, fast and durable procedure for palliation of malignant dysphagia. However, the placement of conventional esophageal endopros-thesis is difficult in some cases and this procedure is associated with significant complications such as perforation, hemorrhage and dysfunetion of the prosthesis in the long term. The self-expanding metallic stents offer an attractive alternative to conventional esophageal stents. These can be compressed into and inserted through a small lumen catheter, making placement easier, safer and less painful to patients. But, open mesh of self-expanding metallic stent such as Wallstent allows tumor ingrowth, unfinished wire ends can lead to perforation and bleeding, and immense stent shortening makes precise positioning difficult. Inflammatory response at site of the metal strut, difficulty in retrieving prostheses that place and very expensiveness in cost-benefit analysis are also problems. Recently developed Ultraflex" esophageal prosthesis is knitted from single strand of Elastalloy' wire, undulates to conform with normal esophageal peristalsis, maintaining patency and promoting patient comfort. Unlike other metallic stent that have sharp, bare-wire ends, the Ultraflex' Stent has smooth looped ends, with Teco-flex coating, which provide an atraumatic transition from the stent to the esophageal wall. We experienced a case of a 60-year old male with malignant stenosis of esophageal cancer in whom Ultraflex esophageal prosthesis was implanted with successful oral nutrition.