The palliation of dysphagia of oesophageal-cardial carcinoma with self-expandable metal prostheses

Oesophageal cancer carries significant morbidity and mortality. The majority of patients can not be cured, thus require palliation. Endoscopic palliation of dysphagia can be achieved with bougienage, tumour ablation or placement of a stent. It has been shown that self-expandable metal stents (SEMS) are superior to plastic stents for palliation of malignant oesophageal strictures.

Patients And Methods: In 2004, at our department 9 patients (2 female, mean age: 59.5 y), underwent implantation of self-expandable metal stents (SEMS) for palliation of dysphagia due to inoperable oesophageal or cardial cancer/8 cases/or for locally recurrent carcinoma after surgery by using covered Ultraflex stent (Boston-Scientific). All stents were inserted via combined endoscopic and fluoroscopic approach. Results: Stent placement was technically successful in all patients. As an early stent related complication, stent placement provoked moderate bleeding in one patient. The bleeding resolved spontaneously, but blood transfusions were required. The in-hospital mortality rate was 22% due to the rapid progression of the disease, although after stent implantation the dysphagia score improved in all patients. All tracheo-esophageal fistulas were successfully occluded. During follow-up, such late complications as food bolus obstruction and stent migration into the stomach were detected in 2 and 1 cases, respectively. Endoscopic treatments of all complications were successful. The mean follow-up period was 14 weeks (4–22 weeks). Three patients died during the follow-up, and 6 cases are still alive.

Conclusions: Placement of SEMS provides effective palliation of patients with incurable malignant dysphagia. Although, the cost of the procedure and the substantial stent-related complication(s) is rather high, but the preoperative mortality rate and the low overall survival time may be improved with the development of better selection criteria.