EXPANDABLE STENTS - UNUSUAL LOCATIONS

Objectives: Expandable metallic prostheses have been used widely for m alignant biliary stenoses and are being used increasingly for malignan t dysphagia and esophago-airway fistulas, Potentially, such prostheses can he placed for gut neoplasms obstructing beyond the esophagus or g astric cardia, This series reports our experience with expandable meta llic stents in tile stomach, jejunum, and colon. Methods: All patients with expandable gastrointestinal stents (other thats biliary tree or esophagus) were reviewed. Indications for stent placement, type and lo cation of prosthesis; patient demographics, procedural problems, and d ata with regard to outcome were defined. Results: Over a 6-yr period, expandable prostheses (Z stent, Esophacoil, and Ultraflex) were placed in nine patients with widespread malignancy (afferent loop obstructio n three; colon obstruction, three; gastric outlet obstruction, two; an d esophagojejunal interposition stricture, one). There was one colon p erforation as a consequence of dilation prior to placement of the pros thesis, Subsequent problems included migration (one), occlusion by foo d bolus (one), and tumor overgrowths/ingrowths (three) which were trea ted with laser. Median survival approximated 9 months. Conclusions: Ex pandable metallic prostheses have the potential to palliate malignant gastrointestinal stenoses that have traditionally been treated with su rgical bypass or comfort care measures only.