Mid-esophagus unresectable cancer treated with a low cost stent. First experience

Abstract

BackgroundIn the cancer of the esophagus, with recent technologic advances, self-expanding metal stents (SEMS) are at the forefront of the armamentarium for re-establishing luminal patency. Weighed against the numerous advantages of stents are the import conditions and the cost. In light of this, we tested new low cost prostheses having the basic needs and characteristics to aim a significant benefit to poor people having advanced esophageal cancer, in a Brazilian regional public hospital.MethodsThis initial experience included fifteen patients (eleven men and four women, 55 ± 6.17 years old), presenting esophageal cancer, located at the medium third of the thoracic esophagus, extending for 5.5-8 cm long, not suitable for surgical procedure because they had been staged on fourth grade of the disease, two of them having fistula communicating esophagus to respiratory tree. The stents were placed under endoscopic and fluoroscopic guidance, after attempting an esophageal dilatation. An appropriate covered stent was then deployed, twelve of 10 cm and three of 13 cm in length. A chest X-ray was done 2 h after the procedure and a barium swallow was performed within 12 hours. Seven days and monthly until complete a six month follow-up after the procedure the patients were questioned about presence of pain, regurgitation, heartburn, cough, and their alimentary behavior.ResultsThere were no severe complications and transient mild chest pain resolved until the seventh day after the stent deployment. Chest X-ray demonstrated expansion of the stent in all patients. In 2 cases of fistula, a barium swallow showed its complete sealing. The completion of the proposed follow-up was not achieved in three cases, limited by the patient's death until the third month, due to cancer progression. Recurrent dysphagia to paste food accounted for by tumor overgrowth proximal or distal to the stent and stent migration were not observed in the series.ConclusionsThe new low cost endoprostheses is effective and forthcoming increased experience and prospective trials including questionnaires to analyze quality of life will allow for more informed decisions tailoring to a particular patient situation or to unexpected complications.

Oesophageal Stenting in Malignant Dysphagia - Factors Associated With Different Complications and Their Effect on Long-Term Prognosis

“…[6,13] The decreasing diameter of delivery system makes perforation a rare occurrence and also covered stent (SEMS) covers the minor perforations during the procedure. [6,13,14] In our series, no patient had oesophageal perforation. This could be because of the fact that we did not over-dilate the stricture, rather dilated to the extent that delivery system of the stent could negotiate across it.…”

Palliation of malignant dysphagia with self expandable esophageal stents

“…Endoscopic laser therapy, electrocautery, and self-expandable esophageal stents can be used to treat this condition, and out of these, stent placement is the most effective, [11] with both SEMS and SEPS being used in malignant dysphagia patients as well as those with ERFs, which develop in cases of advanced esophageal and lung cancer and lead to pulmonary symptoms as a result of the aspiration of secretions and food. [4,13,14] Turkyilmaz et al [15] in their series comprised of 326 patients with malignant esophageal disorder found that ERFs were present in 5% (n=18) of their study participants. Covered stents are suitable for the sealing of fistulas because they can prevent the esophageal contents from passing into the fistula.…”

“…In cases involving malignant esophageal stenosis, the insertion of an expandable stent can markedly improve the quality of life (QoL) for patients with dysphagia. [4] Celestin [8] and Atkinson and Ferguson [9] reported the palliation of malignant dysphagia with a plastic stent in 1959 and the 1970s, respectively, and in 1983, Frimberger [10] introduced the endoscopic placement of an expandable metallic stent. These earlier efforts led to the development of various self-expandable metallic and plastic stents that are in use today, and these are especially beneficial for the palliative treatment of malignant dysphagia in patients with advanced stage.…”

“…In addition, dilation is necessary in most patients, but the maximum degree of dilation has not yet been established. [4] However, it is usually advised to dilate to at least 12 mm, but excessive dilatation may cause stent migration. [16,17] For those who undergo stent implantation, major and minor complications may develop in approximately 2-10% and 20-33% of the patients, respectively, [4,11,18] and Eroglu et al [19] reported that the overall complication rate without chest pain was 31.7% in their series.…”

“…[3] In this stage, some patients suffer from esophageal stenosis or even ERFs as a result of the esophageal carcinoma. [4] Progressive dysphagia is one of the most common devastating complaints of these patients, [4] and radiotherapy, plastic and metal stents, endoscopic ablation, and resection or bypass surgery are normally used for the palliation of malignant dysphagia, [5,6] with esophageal stent placement and radiation therapy being the most used. [6] However, for early palliation of dysphagia in advanced esophageal cancer patients, self-expandable plastic stent (SEPS) insertion prior to chemotherapy may be an appropriate alternative.…”