Self-Expanding Metal Stents for Endoscopic Treatment of Esophageal Achalasia Unresponsive to Conventional Treatments. Long-Term Results in Eight Patients

Background and Study Aims: The successful use of self-expanding metal stents has been demonstrated in the management of malignant esophagocardial strictures. This report assesses the role stents may play in the treatment of esophageal achalasia in selected patients.

Patients and Methods: Between September 1996 and December 1997, eight patients (two men, six women; average age 67.6 years) underwent insertion of a self-expanding metal stent for management of achalasia. Previous myotomy and/or balloon dilation or injection of botulinum toxin had failed in all patients. Four nitinol coil stents and five covered Ultraflex stents, 10 cm long, were inserted, being passed through the gastroesophageal junction under mild sedation.

Results: Stent placement was successful and uncomplicated in all patients. Early complications were seen in five patients: chest pain (1), gastroesophageal reflux (1), proximal migration (1), and distal migration (2). One patient underwent surgery for stent impaction in the colon. During the follow-up period of 35.5 months, on average (range 29 - 44 months), four patients experienced complications: chest pain (2), reflux esophagitis (1) and stent migration (1).

Conclusion: General use of self-expanding metal stents for esophageal achalasia cannot be recommended.

References

• 1 Knyrim K, Wagner H J, Bethge N, et al. A controlled trial of an expandable metal stent for palliation of esophageal obstruction due to inoperable cancer.  N Engl J Med. 1993;  329 1302
• 2 De Palma G D, Di Matteo E, Romano G, et al. Plastic prosthesis versus expandable metal stents for palliation of inoperable thoracic carcinoma: a controlled prospective study.  Gastrointest Endosc. 1996;  43 478
• 3 De Palma G D, Catanzano C. Removable self-expanding metal stents: a pilot study for treatment of achalasia of the esophagus.  Endoscopy. 1998;  30 95-96
• 4 Vantrappen G, Hellemans J. Treatment of achalasia and related motor disorders.  Gastroenterology. 1980;  79 144
• 5 Ferguson M K. Achalasia: current evaluation and therapy.  Ann Thorac Surg. 1991;  52 236
• 6 Pasricha P J, Ravich W J, Hendrix T R, et al. Intrasphincteric botulinum toxin for treatment of achalasia.  N Engl J Med. 1995;  332 774
• 7 Swanstrom L L, Penning J. Laparoscopic esophagomyotomy for achalasia.  Surg Endosc. 1995;  9 286
• 8 Sandha G S, Marcon N. Expandable metal stents for benign esophageal obstruction.  Gastrointest Endosc Clin N Am. 1999;  9 437-446
• 9 Fiorini A, Goldin E, Corti R, et al. Self expanding coil metal stent for management of esophageal benign rigid strictures unresponsive to conventional treatments (abstract).  Gastrointest Endosc. 1997;  45 16