Self-expanding metallic intraluminal stents for palliation of esophageal cancer

Background: The use of self-expanding metallic stents for esophageal cancer is gaming popularity as an option for palliation of dysphagia. Its safety and efficacy requires more evaluation. Method: Prospectively collected data on 19 consecutive patients who underwent endoscopic placement of metallic stents were reviewed. Results: The median age was 72 (range 42-92) with 15 male and 4 female patients. Upper third, middle third, lower third tumors and cancer affecting the gastroesophageal junction (GEJ) were found in 3,10,3 and 3 patients respectively. The indications for stenting were locally advanced and metastatic tumor in 11 patients, advanced tumor with poor medical risk for surgery in 6, and poor medical risk in 2. In 5 patients tracheobronchial tree infiltration was also evident. Five patients had prior chemotherapy. Membrane coated wire-mesh stents (Wallstent®) were used in 14 patients while uncoated spring-coiled stents (EsophaCoil®) were used in 5. In 6 patients, the distal end of the stent was located below the GEJ. No esophageal perforation was encountered and there was no procedure-related mortality. The median pre-stent dysphagia score was 4 (fluids only), while the median post-stent score was 2 (semi-solid). Most patients maintained alimentation orally until their near terminal state. Seven patients required further endoscopic interventions, in four of whom only one procedure was required because of food bolus obstruction. One patient whose Wallstent® straddled the GEJ migrated into the stomach. A second Atkinson tube was placed which remained patent until his death. In the other two patients, tumor overgrowth at either ends of the stents required endoscopic dilatation. Median survival post stenting was 2.7 months. Conclusions: Self-expanding metallic stents are safe and effective in palliating malignant dysphagia. Procedure-related complications are infrequent. The overall migration rate is low though caution is warranted in stents which straddle the gastroesophageal junction.