MALIGNANT DYSPHAGIA - PALLIATION WITH ESOPHAGEAL STENTS - LONG-TERM RESULTS IN 100 PATIENTS

PURPOSE: To evaluate the long-term palliative effect of self-expanding nitinol esophageal stents in patients with malignant dysphagia. MATER IALS AND METHODS: One hundred patients with severe dysphagia secondary to malignant esophageal strictures were treated with self-expanding n itinol stents. The strictures were caused by squamous carcinoma (n = 4 3), adenocarcinoma (n = 28), anastomotic tumor recurrence (n = 14), an d mediastinal tumor (n = 15). RESULTS: One hundred six stents were suc cessfully positioned in 100 patients. Attempts to insert a second, coa xial stent were unsuccessful in two patients; a second stent was place d incorrectly in another patient. Statistically significant (P<.001) r eduction of dysphagia was noted after expansion of the stents. Complic ations consisted of incomplete expansion secondary to stent twisting ( n = 4), stent migration (n = 4), tumor ingrowth (n = 17), tumor overgr owth (n = 3), food impaction (n = 5), fracture of stent wires (n = 2), benign strictures at stent edges (n = 2), tumor bleeding (n = 3), and esophagorespiratory fistula (n = 5). The primary patency rate was 75% (77 of 102 stents); the secondary patency rate was 94% (96 of 102 ste nts). The survival time (mean, 6.2 months; range 0.1-47 months) varied with the diagnosis. CONCLUSION: Placement of self-expanding nitinol s tents is safe and has a good long-term palliative effect on dysphagia in patients with malignant esophageal strictures.