Self‐expandable Metal Stents for Malignant Dysphagia

Lam, Y. H.; Chan, Angus C.W.; Lau, James Y.; Lee, Danny; Ng, Enders Kwok Wai; Wong, SK; Chung, Sydney S.C.

doi:10.1046/j.1440-1622.1999.01661.x

Cited by 17 publications

(24 citation statements)

References 13 publications

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“…In this study stenting was used as the primary treatment modality in only 12% of patients. Stents offer the advantage of immediate palliation of dysphagia in 75–95% of patients, with more than two‐thirds of modern stents remaining patent until the patient's death 11,12 . Generally only an overnight stay in hospital is required, with the patient will be able to tolerate a softened diet the following day.…”

Section: Discussionmentioning

confidence: 99%

“…Uncovered stents are significantly more susceptible to tumor ingress whereas knitted stents have a low expansile force and distal stent migration can be problematic 14 . In a series of 82 patients published by Lam from Hong Kong, 39% of patients required re‐intervention following stenting as the primary treatment modality 12 . Another series of 40 patients from Germany reported re‐intervention was required for more than half the patients after a median follow‐up period of 10 weeks 15 .…”

Section: Discussionmentioning

confidence: 99%

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Chemoradiation therapy is effective for the palliative treatment of malignant dysphagia

Harvey

Bessell

Beller

et al. 2004

Diseases of the Esophagus

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Between 1993 and 2001, 106 patients with esophageal cancer were reviewed at a multidisciplinary clinic and treated with palliative intent by chemoradiation therapy. This study assesses the palliative benefit on dysphagia and documents the toxicity of this treatment. The study population comprised 72 men and 34 women with a median age of 69 years. Patients were treated with a median radiation dose of 35 Gy in 15 fractions with a concurrent single course of 5 FU-based chemotherapy. Dysphagia was measured at the beginning and completion of treatment and at monthly intervals until death, using a modified DeMeester (4-point) score. Treatment was well tolerated, with only 5% of patients failing to complete therapy. The treatment-related mortality was 6%. The median survival for the study population was 7 months. The median baseline score at presentation was 2 (difficulty with soft food). Following treatment, 49% of patients were assessed as having a dysphagia score of 0 (no dysphagia). Seventy-eight per cent had an improvement of at least one grade in their dysphagia score after treatment. Only 14% of patients showed no improvement with treatment. Fifty-one per cent maintained improved swallowing until the time of last follow-up or death. This single-institution study shows that chemoradiation therapy administered for the palliation of malignant dysphagia is well tolerated and produces a sustainable normalization in swallowing for almost half of all patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Chemoradiation therapy is effective for the palliative treatment of malignant dysphagia

Harvey

Bessell

Beller

et al. 2004

Diseases of the Esophagus

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“…Restrictures were often found resulting from tumor overgrowth or growth through the stent meshes or benign hyperplasic tissues at the edge of stents discovered during long-term follow up [9,13] . A coated stent placement may prevent tumor ingrowth, but cannot prevent overgrowth of tumors and benign hyperplasic tissues at the edge of stents, but a secondary stent insertion may solve this problem.…”

Section: Discussionmentioning

confidence: 99%

“…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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“…In addition to high rates of technical success, SEMS are highly efficacious in their ability to palliate dysphagia and close malignant fistulae. Multiple case series and meta-analyses performed over the past 20 years suggest immediate improvement in clinical symptoms in 90-100% of patients (Cook and Dehn 1996;Christie et al 2001;Bethge et al 1998;Raijman et al 1994Raijman et al , 1998Song et al 1994;Fiorini et al 1995;De Palma et al 1995Moores and Ilves 1996;Lam et al 1999;Toikkanen et al 2000;Cordero and Moores 2000;Vakil et al 2001;Razzaq et al 2001;McGrath et al 2001;Kostopoulos et al 2003;Johnson et al 2006;Costamagna et al 2006;Sundelof et al 2007;Xinopoulos et al 2005). Despite these high technical and initial clinical success rates, the need for re-intervention remains significant with up to 1/3 of patients experiencing recurrent dysphagia from tumor in-growth or tissue hyperplasia at the proximal or distal stent margins.…”

Section: Discussionmentioning

confidence: 99%