USE OF COVERED EXPANDABLE METAL STENTS IN THE TREATMENT OF ESOPHAGEAL-CARCINOMA AND TRACHEOESOPHAGEAL FISTULA

Palliation for malignant dysphagia has relied on oesophageal dilatatio n, insertion of rigid prostheses and laser treatment. All three method s have substantial risk of perforation. Displacement of the tube is al so well described. Seventeen expandable polyethylene-covered metal ste nts were inserted in 15 patients with oesophageal carcinoma; there wer e 11 men and four women, of median age 70 years. Thirteen stents were inserted for dysphagia and four for tracheo-oesophageal fistula (TOF). Stents were inserted endoscopically under fluorosopic control. Seven patients died from their disease a median of 5 (range 1-11) months aft er stent insertion. Median follow-up in the remainder is 6 (range 1-11 ) months. Median dysphagia scores before and after insertion were 3 (r ange 2-4) and 1 (range 1-2) respectively. Stent insertion provided cur e of symptoms in patients with TOF. Median hospital stay following ins ertion was 2 (range 1-20) nights. There were no deaths and no perforat ions associated with the procedure. Two patients complained of retrost ernal chest pain for 2 days after stent insertion. One patient present ed with dysphagia related to later stent migration. There has been no deterioration in symptoms of dysphagia in the remainder. Expandable oe sophageal stents offer a safe alternative to traditional methods of pa lliative treatment for oesophageal carcinoma. In the longterm they may provide a cost-effective alternative to standard treatments.