PALLIATION OF MALIGNANT ESOPHAGEAL STRICTURES WITH SELF-EXPANDING NITINOL STENTS - DRAWBACKS AND COMPLICATIONS

PURPOSE: To evaluate the usefulness of self-expanding nitinol stents i n the palliative treatment of malignant dysphagia. MATERIALS AND METHO DS: Eighty self-expanding nitinol stents Were placed in 59 patients (4 3 men, 16 women; mean age, 55 years; age range, 23-75 years) with inop erable malignant stenosis due to squamous cell carcinoma of the esopha gus (n = 36), adenocarcinoma (n = 19), invasion of the esophagus due t o carcinoma of the lung (n = 2), and recurrent anastomotic carcinoma ( n = 2). Dysphagia was graded on a scale of 0 to 3. Follow-up esophagog rams were obtained to evaluate stent patency. RESULTS: Stent placement was successful in all patients. The severity of dysphagia decreased a t least one grade in all but one patient. Tumor ingrowth and overgrowt h were seen in 21 (36%) patients 2 days to 7 months after stent placem ent and caused recurrent dysphagia. These 21 patients underwent balloo n dilation and additional stent placement. A mediastinal fistula was s een in three patients (5%), ulceration in four (7%), stent torsion in three (5%), and incomplete expansion of the stent in two (2%). Repeat intervention was necessary in 51% of the patients. CONCLUSION: There i s a substantial range of drawbacks and complications associated with t he use of self-expanding nitinol stents for palliation of malignant es ophageal strictures. A covering would be necessary to prevent tumor in growth.