Self-expanding stents are a well-accepted palliative treatment modality for strictures resulting from esophageal carcinoma.
However, the use of stents close to the upper esophageal sphincter is considered to be limited by patient intolerance caused by pain and globus sensation.
The use of stents increases the risk of complications, particularly tracheoesophageal fistula formation and aspiration pneumonia.
|Recurrent dysphagia occurred in 28% of patients|
Dr Els Verschuur and colleagues from the Netherlands determined the efficacy and safety of stent placement in patients with a malignant obstruction close to the upper esophageal sphincter.
Evaluation of 104 patients with dysphagia from a malignant stricture close to the upper esophageal sphincter treated in the period from 1996 to 2006.
The team identified 66 patients with primary esophageal carcinoma, and 38 with recurrent cancer after gastric tube interposition within 8 cm distance distal of the upper esophageal sphincter.
The team found that 23% of patients also had a tracheoesophageal fistula.
Functional and technical outcome, survival, complications, and recurrent dysphagia.
Analyses were performed by chi-squared test, Kaplan-Meier curves, and log-rank testing.
The researchers found that mean distance from the upper esophageal sphincter to the upper tumor margin was 5 cm, and 3 cm to the upper stent margin.
The procedure was technically successful in 96% of patients.
Fistula sealing was achieved in 79% of patients.
After 4 weeks, dysphagia had improved from a median score of 3 to 1.
Total complications were seen in 33% of patients.
The team found of these, major complications included aspiration pneumonia, hemorrhage, and fistula after stent placement.
Perforation occurred in 21% of patients, whereas pain after stent placement was observed in 15% of patients.
Recurrent dysphagia occurred in 28% of patients and was mainly caused by tissue ingrowth or overgrowth, food bolus obstruction, and stent migration.
The researchers found that other reasons included persistent fistula, difficulty with swallowing, and dislocation of the stent.
The team found that 8% of patients complained of globus sensation.
However, in none of the patients was stent removal indicated.
Dr Verschuur's team concluded, "Stent placement is safe and effective for the palliation of dysphagia and sealing of fistulas in patients with a malignant stricture close to the upper esophageal sphincter."
"On the basis of these results, stent placement may be considered for palliation in this group of patients with an otherwise dismal prognosis."