TREATMENT OF ESOPHAGEAL OBSTRUCTION FROM MEDIASTINAL COMPRESSIVE TUMORS WITH COVERED, SELF-EXPANDING METALLIC Z-STENTS

Background: Mediastinal malignancies may involve the esophagus, leadin g to esophageal stenosis and dysphagia. Rigid and self-expanding esoph ageal stents have been used for effective palliation, but their use in extrinsic, compressive lesions is controversial. Methods: A retrospec tive review of self-expanding Gianturco-Rosch Z-stents that were succe ssfully placed in 13 patients with malignant esophageal obstruction du e to extrinsic lesions. Results: All patients had an improvement in dy sphagia of at least two dysphagia grades. The mean dysphagia grade fel l from 3.15 to 0.62. Mean survival was 2.2 months. Early (within 48 ho urs) procedure-related complications occurred in 4 of 13 patients and consisted of minor, transient chest pain that resolved within 6 hours (3 patients) and endoscopic stent dislodgment into the stomach (1 pati ent). Late complications (>48 hours) occurred in 2 patients and consis ted of a partial proximal stent migration and the development of a ben ign stricture proximal to the stent. There was no procedural or stent related mortality.Conclusions: Esophageal obstruction and malignant dy sphagia from extrinsic, compressive mediastinal malignancies can be ef fectively and safely palliated with self-expanding Gianturco-Rosch Z-s tents.