Chest Pain Following Oesophageal Stenting for Malignant Dysphagia

Golder, Mark; Tekkis, Paris; Kennedy, C; Lath, Sadaf; Toye, R.; Steger, A. C.

doi:10.1053/crad.2000.0609

Cited by 16 publications

(11 citation statements)

References 13 publications

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“…Although placement of metallic stents could lead to some complications [2,17] , such as chest pain, bleeding, perforation, fistula, restricture, and approximately 0.5-2% of patients died as a direct result of placement of metallic stents, but most patients had a long-term (1-82 wk, mean 53 wk) palliation [13] . It is thus concluded that metallic stent placement is a simple, quick, safe and efficient method to palliate esophageal carcinoma obstruction.…”

Section: Discussionmentioning

confidence: 99%

Clinical application of metallic stents in treatment of esophageal carcinoma

Yang¹

2004

WJG

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AIM:To evaluate the effects of self-expanding metal stents (SEMS) in patients with malignant esophageal obstruction and to analyze their prognosis and complications. METHODS:Seventy-four metallic stents were placed under fluoroscopic guidance in 66 patients with esophageal obstruction secondary to carcinoma, of whom, 6 cases were complicated by fistula. RESULTS:After seventy-two stents were successfully used in 66 cases without any severe complications (technical successful rate was 97%), the dysphagia score improved from 3.3±0.6 to 0.8±0.5 (P<0.01), and life quality improved significantly in all these patients. All fistulae were sealed immediately after coated stents were inserted in the six patients. New stents were placed in two patients: the stent migrated more than 2 cm, in one patient and the stent slipped into stomach in the other. Minor bleeding was found only in 28 patients during the operation. Reobstruction was found in 12 patients, but was successfully cured under endoscopy. The survival rate was 78%, 57% and 11% for 6 mo, 1 year and 2 years respectively. CONCLUSION:Placement of SEMS is a simple, safe, quick and efficient surgical method for treating esophageal carcinoma obstruction. It may be used mainly as a palliative treatment of esophageal obstruction secondary to carcinoma.

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Section: Discussionmentioning

confidence: 99%

Clinical application of metallic stents in treatment of esophageal carcinoma

Yang¹

2004

WJG

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“…Chest pain is common and occurs in 10-60% of patients after placement, 50% of whom require opiate analgesia. 179,187,188,207,208 Disabling pain is more common with the large diameter SEMS. 189,190 Although many series report no procedure-related perforations, they can and do occur in 4-7% of procedures.…”

Section: Complicationsmentioning

confidence: 99%

“…Golder and colleagues monitored daily opioid analgesic requirements in 52 patients palliated with SEMS and found that 26 patients (50%) required opioid analgesia within 48 hours of the procedure (median dose: 80 mg morphine/day). 207 This could decrease conscious levels and increase the risk of aspiration pneumonia, especially if the SEMS straddles the oesophagogastric junction. 173,181,197 The effect of post-treatment pain on quality of life has not been reported previously and has significant implications for treatment with a SEMS.…”

Section: Quality Of Lifementioning

confidence: 99%

A pragmatic randomised controlled trial of the cost-effectiveness of palliative therapies for patients with inoperable oesophageal cancer

Shenfine

McNamee²,

Steen³

et al. 2005

Health Technol Assess

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It was suggested that rigid tubes and 24-mm SEMS should no longer be recommended and bipolar electrocoagulation and ethanol tumour necrosis should not be used for primary palliation. The choice in palliation would between non-stent and 18-mm SEMS treatments, with non-stent therapies being made more available and accessible to reduce delay. A multidisciplinary team approach to palliation is also suggested. A randomised controlled clinical trial of 18-mm SEMS versus non-stent therapies with survival and quality of life end-points would be helpful, as would an audit of palliative patient admissions to determine the reasons and need for inpatient hospital care, with a view to implementing cycle-associated change to reduce inpatient stay. A study of delays in palliative radiotherapy treatment is also suggested, with a view to implementing cycle-associated change to reduce waiting time.

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“…When relief of dysphagia symptoms and life-threatening complications are taken into account, self-expandable metallic stent (SEMS) application has seen an increase at this time. 1,2 SEMS application is easier and has the advantage of rapid relief of dysphagia compared with other therapeutic methods. In contrast, life-threatening early and late complications can develop after stent placement.…”

mentioning

confidence: 99%