SILICONE-COVERED SELF-EXPANDING METALLIC STENTS FOR THE PALLIATION OFMALIGNANT ESOPHAGEAL OBSTRUCTION AND ESOPHAGORESPIRATORY FISTULAS - EXPERIENCE IN 32 PATIENTS AND A REVIEW OF THE LITERATURE

Esophagogastric malignancies often are manifested with progressive dys phagia or esophagorespiratory fistulas. Palliative modalities currentl y available have significant limitations. A modified Gianturco-Rosch s ilicone-covered self-expanding metallic Z stent was used in 32 consecu tive patients with malignant esophageal obstruction (n = 24) or esopha gorespiratory fistulas (n = 8). The stent was placed successfully in a ll patients. Dysphagia improved by at least two grades in 21 of the 24 patients (87.5%); the mean dysphagia grade fell from 3.21 to 1.08. Si x of the 8 patients with fistulas were able to resume a normal diet, a nd the ether 2 were able to eat solids without symptoms of aspiration. Complications occurred in 10/32 patients (31%) and included stent mig ration (4 patients), food impaction (2 patients), membrane disruption with tumor ingrowth (1 patient), tumor overgrowth (1 patient), early p ressure necrosis with hemorrhage (1 patient), and late pressure necros is with sepsis (1 patient). The latter 2 patients died, giving a morta lity rate of 6.3%. Many complications were managed with endoscopic or interventional radiologic techniques. Although randomized prospective clinical trials are needed, the silicone-covered Gianturco-Rosch Z ste nt offers promise for the effective paliiation of malignant esophageal obstruction and esophagorespiratory fistulas.