TREATMENT OF MALIGNANT ESOPHAGEAL OBSTRUC TION WITH A SELF-EXPANDING ELASTALLOY(TM) STENT

12 patients with malignant inoperable esophageal obstruction (carcinom a of the esophagus n = 7, carcinoma of the esophagogastric junction n = 3, mediastinal lymph node metastasis n = 2) and high-grade dysphagia were treated with self-expanding metal stents (Ultraflex(TM), Microva sive(R)) made of a nickel titanium alloy (Elastalloy(TM)). Other forms of palliation had failed in 9/12 patients. The degree of palliation w as expressed as a dysphagia score (0-4) before and after stent inserti on. The stents were inserted under endoscopic and fluoroscopic control . They were placed successfully and without complications in all patie nts. A good functional result was achieved in 11 patients (91.7%). Thu s, the dysphagia score decreased significantly from 3.2+/-0.4 before t o 0.9+/-1.0 immediately after stent insertion (p <0.001). The remarkab le relief of dysphagia was sustained during a mean follow up of 101 da ys (10-278) with a dysphagia score of 1.1+/-1.0 at the end of the stud y (p <0.001 compared to the score before the procedure). In one patien t with mediastinal lymph node metastasis the stent expanded insufficie ntly. 7 days after insertion it was removed endoscopically and replace d successfully by another stent with a stronger expansive force ((Inst ent(TM)). 3 patients experienced recurrent dysphagia(food impaction n = 1, tumor ingrowth through the meshes of the stent n = 2). They were successfully treated by an endoscopical intervention (endoscopical des obliteration n = 1, laser therapy n = 1, insertion of a Wallstent(TM) n = 1). At the end of the study, 6 patients were alive, 6 patients wer e dead with a mean survival of 56 days (10-117). In conclusion, the se lf-expanding metal stent made of Elastalloy(TM) provides rapid, safe a nd very effective palliation for patients with esophageal obstruction due to inoperable cancer. Although recurrent dysphagia may occur, it i s easily treated by endoscopy.