Evaluation of nitinol stent placement complications for palliation of malignant dysphagia

Abstract

14120 Background: Over 50% of patients (pts) with obstructive carcinoma are inoperable at the time of the diagnosis and only 18% of them survive beyond a year. Palliative treatment must be quickly effective, safe, well tolerated and focused to relieve symptoms, improving the nutritional state and quality of life. The objective of the study was to investigate the clinical effectiveness and complications of palliative treatment with esophageal stent placement. Methods: Descriptive and prospective study about functionality of nitinol autoexpandible stent was carried out. Evaluable pts included those with confirmed histological diagnosis of inoperable or unresectable esophageal cancer, with some clinical contraindication due to risk or personal rejection. An immediate post placement follow-up was performed after 24hours, 7 and 30 days, to evaluate the stent proper location, its permeability as well as its degree of expansion, presence of epigastric or precordial pain, reflux and degree of dysphagia. Results: From August/02 to September/05 stent was placed in 20 people, 9 women and 11 men, mean age 67.8 (range: 42–85). The autoexpandible stent placement was achieved in 100% of pts (3 = gastric carcinoma and 17 = esophagus carcinoma). Histological diagnosis was epidermoid (11 pts) and adenocarcinoma (9 pts). Inoperable malignant stricture was as follows: lower third: 11 pts (55%), middle third: 9 pts (45%). A second stent was required in 2 pts. Median time of hospitalization was 48 hours.Immediate complications appeared in 12 pts: pain 3 (15%), vomiting 3 (15%), pneumonia 2 (10%), cough 1 (5%), pyrosis 1 (5%). After 24 hour control: pain 2(10%), respiratory complications 2 (10%). The delayed ones were as follows: level 4 dysphagia 2 (10%), pain 8 (40%), reflux 5 (25%). No mortality related to stent placement was observed. Dysphagia was perceptibly reduced, from 3.0 to 1, (p < 0,005). Conclusion: The nitinol stent is easy to place, it provides effective palliation of malignant esophageal obstruction with short hospitalization time and low risk of serious complications. No significant financial relationships to disclose.