[Safety and efficacy of stenting in malignant esophageal obstruction: a prospective study]

ABSTRACT

Palliative procedures in esophageal cancer to restore swallowing are preferable to- major surgery in most cases. The aim of this prospective study was to provide further information on treatment techniques, complications, and survival in the patients with malignant esophageal obstruction undergoing endoscopic palliative therapy using Self-Expanding Metal Stents [SEMS]. Patients with obstruction of the esophagus secondary to carcinoma who referred for stenting with SEMS between October 2004 and July 2005 were studied. In all cases the tumor was considered non-respectable and the stage of the disease was III or IV. All patients had aphagia or severe dysphagia to liquids and saliva, due to which, stenting was indicated. A follow-up in 1-11 months was taken, with physical and laboratory examinations. Symptom relief, survival rate, and complications were analyzed using Wilcoxon signed ranks test and student t-test by SPSS software version 10.0. Results were considered statistically significant for p<0.05. Between October 2004 and July 2005 twenty two stents were placed under fluoroscopic guidance in 19 patients [13 males and 6 females with mean age of 65.5+/-12.6 years] with the obstruction of the esophagus secondary to carcinoma. Technical success rate was 100%. The dysphagia score improved significantly in a month after stenting [p=0.001]. During this time period, appetite score of the patients was not improved significantly [p=0.070]. Major immediate complications including severe pain occurred in two patients [10.5%]. Eight [42.1%] patients died. The survival rate was 68.4%, 63.2% and 57.9% for 3, 6 and 9 months, respectively. Our results suggest that self-expandable metallic stent placement is a simple, quick, safe and efficient method to palliate esophageal carcinoma obstruction and its implantation will efficiently palliate dysphagia. The major problem of these patients, however, seems to be loss of appetite due to the underlying disease