Covered self-expanding metal stent in palliative treatment of dysphagic patient with end-stage malignancy of cardia: the first experience in stent placement and literature review

ABSTRACT

More than 50% of patients with carcinoma of the esophagus or gastric cardia have incurable disease at presentation and require palliative treatment for dysphagia. Insertion of a self-expanding metal stent has become the treatment of choice for these patients. We report successful placement of a covered self-expanding metal stent in a patient with malignant squamous cell carcinoma [SCC] of esophagogastric junction. A 62-year-old man referred to the gastrointestinal division of the 501 medical center, Tehran, Iran due to dysphagia. During upper gastrointestinal endoscopy, a seven cm tumor was seen 35 cm distal to dental line. Histologic examination of the biopsy samples confirmed malignant SCC. The tumor was in stage Ill/IV and therefore it was inoperable. Palliative therapy with 11-cm covered Choo stent [Mi-Tech Ltd., Seoul, South Korea] was considered for this patient. On March 12, 2006 after sedation with midazolam, the stent was placed under the fluoroscopic and endoscopic guide. The patient underwent radiotherapy, thereafter. During the two-month follow-up, the patient's general condition recovered and he gained weight. Fluoroscopically guided insertion of covered self-expanding metal stents is a safe and comfortable method of palliation for patients suffering with malignant dysphagia. For prevention of restenosis, covered types should be given priority