Abstract
Eleven self-expanding metal stents were perorally implanted in ten patients with locally
advanced malignant obstruction of the esophagus. After bougienage of the strictures,
the stents were painlessly inserted and properly released by means of an 18 French
gauge delivery catheter. In all cases, the endoprostheses expanded to a diameter of
14-20 mm and achieved immediate improvement of dysphagia. One perforation was seen
after a single session of dilatation and subsequent stent insertion. No other early
complication was observed. After a median follow-up of 74 days (Range, 33-252 days),
one of eight patients is still alive and 7 died of non-procedural causes. The grade
of dysphagia improved from a mean of 2.9 to a mean of 1.6 and 2.0, respectively, depending
on the follow-up period (scale 0-4). Esophageal reobstruction occurred in four patients
due to food impaction (two patients) or tumor ingrowth into the stent through the
wire mesh (two patients). Recanalisation of the obstructed stent lumen was achieved
by endoscopic irrigation (two patients), laser therapy only (one patient) or diathermia
with subsequent insertion of a conventional plastic endoprosthesis into the metal
stent (one patient). The initial results are promising. The delivery system, the wide-bore
diameter, the macroporous configuration and the low mass of the self-expanding stents
would seem to be associated with a less traumatic insertion procedure and a lower
rate of stent migration as compared with conventional prostheses. Technical improvement
may be required for prevention of tumor infiltration. Controlled trials are warranted
to determine the future role of metallic stents for palliation of esophagocardial
tumors.
