Placement of self-expanding metal stents is regarded as a safe and effective treatment in patients with incurable malignant esophagogastric obstruction.
The possible benefit of re-interventions in patients with recurrent dysphagia due to delayed complications is unclear.
|Complications were successfully treated by dilatation in 24%|
|Digestive Disease and Science|
Dr Nils Homann and colleagues from Germany evaluated 133 patients with malignant stricture of the esophagus or the esophagogastric junction.
The team reported that 164 expandable metal stents were placed.
About 89 patients were followed up until death.
All tumor- or stent-related complications and consequent re-interventions were recorded.
The researchers found that the overall incidence of delayed complications was 53%, with 26% experiencing more than 1 complication.
Complications included recurrent dysphagia due to tumor ingrowth in 22%, or overgrowth occurring in 15%, and bolus obstruction in 21%.
Stent migration occurred in 9%, and development of esophagorespiratory fistula occurred in 9% of patients.
Complications were successfully treated by dilatation in 24%, placement of a second/third stent in 27%, laser therapy in 16%, and placement of a feeding tube in 19%.
The team found the median survival of patients with endoscopic therapy was significantly longer compared to patients without re-intervention.
Dr Homann's team concluded, "Delayed complications after metal stent placement for malignant esophageal stricture are common, but can be treated successfully by endoscopic re-intervention in most cases."
"Regular interventional therapy may also improve survival."