Two stents for simultaneous esophageal and gastric cancer

Simultaneous isolated tumors of the esophagus and stomach can occur as synchronous tumors or as intramural metastases of one of the tumors. Although most esophageal and gastric cancers share some risk factors, and although they are the most frequently associated cancers, actual synchronicity is very rare [1] [2]. We describe the first case of synchronous endoscopic insertion of stents for synchronous obstructing tumors.

A 91-year-old woman was admitted to an outside hospital with progressive solid-food dysphagia, vomiting, and weight loss. Upper endoscopy showed an obstructing tumor at the gastrointestinal junction. Due to her advanced age and high surgical risk, the patient was transferred to our institution for palliative stent placement.

On repeat endoscopy, the tumor at the gastrointestinal junction (squamous cell carcinoma) nearly obstructed passage of the gastroscope. A Savary-Gilliard dilation up to 11 mm was performed ([Fig. 1]), allowing the gastroscope to pass. However, in the gastric antrum, a second, prepyloric and also nearly obstructing synchronous tumor was discovered ([Fig. 2]). Although with difficulty, the gastroscope was passed into the duodenum.

Fig. 1 Savary-Gilliard dilation of the gastrointestinal junction obstructed by tumor in a 91-year-old woman.

Fig. 2 Synchronous tumor in the gastric antrum: prepyloric and also nearly obstructing.

After discussion, we decided to insert two separate stents. A therapeutic gastroscope could not be passed through the obstruction at the gastrointestinal junction, so a first stent (Ultraflex, partially covered, 100/18 mm; Boston Scientific, Natick, Massachusetts, USA) was inserted across the junction. The obstruction was so tight that the stent would not open fully and a therapeutic scope could not pass ([Fig. 3]). The procedure was stopped and a new examination was scheduled for the following week in order to allow the nitinol stent to open fully with time.

Fig. 3 Tight obstruction at the gastrointestinal junction. The stent did not open fully at first.

On the third endoscopy, the therapeutic scope now easily passed through the gastrointestinal junction stent, and a second stent (pyloroduodenal Wallstent, 90/22 mm; Boston Scientific) was inserted across the second, prepyloric tumor (an adenocarcinoma) ([Fig. 4]).

Fig. 4 One week later, the nitinol stent had opened fully and the therapeutic scope easily passed across both stents.

Two months later, the patient was alive and eating solid food without dysphagia or vomiting.

Endoscopy_UCTN_Code_TTT_1AO_2AZ

Competing interests: None

• References

• 1 Pasławski M, Złomaniec J, Rucińska E et al. Synchronous primary esophageal and gastric cancers. Ann Univ Mariae Curie Sklodowska Med 2004; 59: 406-410
• 2 Koide N, Adachi W, Koike S et al. Synchronous gastric tumors associated with esophageal cancer: a retrospective study of twenty-four patients. Am J Gastroenterol 1998; 93: 758-762