Esophacoil Expanding Stent in the Management of Patients with Nonresectable Malignant Esophageal or Cardiac Neoplasm: A Prospective Study

Introduction

Metallic self-expanding stents for palliative intubation of nonresectable malignant esophageal strictures provide an important improvement in the management of the frail and often elderly patients. The endoscopically guided insertion is facilitated by narrow introduction systems which need only minimal preliminary dilatation. The risk of perforation or rupture is minimized by the gradual expansion of the stent along the whole length [1] [2].

Covered stents are resistant to tumor ingrowth [3] [4]. The cover, however, can make the surface slippery, leading to a tendency for migration of the stent.

The Esophacoil is a biocompatible metal stent made from Nitinol. It consists of a long flat “memory” spiral wire which has a very strong self-expansion force. The latter, together with the tulip-shaped open coil fixation sections at each end, minimizes the risk of migration. The complete retraction of the spiral prevents tumor overgrowth, as with covered stents. It is flexible and adapts easily to angulated strictures (Figure [1]). The stent can be removed by pulling the wire through a protective stiffening tube applied over the gastroduodenoscope.

After release there is a 50 % shortening of the stent length; this must be taken into consideration during application, because after the first step in the three-step releasing procedure, repositioning is difficult.

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