MEMORY METAL STENTS FOR PALLIATION OF MALIGNANT OBSTRUCTION OF THE ESOPHAGUS AND CARDIA

Thirty patients with incurable malignant obstruction of the oesophagus and cardia were treated with self expanding oesophageal memory metal stents (Ultraflex) in a prospective study. The endoprostheses were suc cessfully placed in all patients. Within one week after implantation d ysphagia had improved in 25 of 30 patients (83%). Stent expansion was incomplete within one week after implantation in 12 of 30 patients (40 %). After an average of two dilatation sessions eight of 12 stents had expanded completely. Five patients complained of retrosternal pain an d three of them suffered from heartburn over several days despite acid inhibition. Major problems in the follow up period occurred in 10 of 30 patients (30%) and included late perforation (one) and tumour ingro wth/overgrowth (nine). All of these complications were treated endosco pically. Improvement of the dysphagia of the with tumour ingrowth/over growth lasted for about eight weeks (median; range: 2-38 weeks). Until November 1994 six of 30 patients were still alive with a survival tim e of 309 days (median; range: 103-368 days). It is concluded that oeso phageal memory metal stents are easy to implant, prove effective in th e palliation of malignant oesophageal obstructions, and have a low ris k of severe complications. The only disadvantages are that incomplete initial stent expansion as well as tumour ingrowth/overgrowth occurred in nearly one third of the patients.