Self-expanding oesophageal metal stents for the palliation of dysphagia due to extrinsic compression

The role of self-expanding metallic stents is well established in the palli ation of oesophageal stenosis and dysphagia due to primary oesophageal mali gnancy. However, their role in palliation of dysphagia due to external comp ressive mediastinal malignancies is not well established. The purpose of th is study was to assess the efficacy of self-expanding metallic stents in th e palliation of dysphagia due to extrinsic oesophageal compression by media stinal malignancy. Between January 1995 and January 1998, 21 patients with oesophageal compression due to malignant mediastinal tumours underwent oeso phageal stent placement for palliation of dysphagia. Complete data were ava ilable in 17 patients (10 men and 7 women). The mean age was 63.5 years (ra nge 46-89 years). A total of 19 stents were placed successfully. The dyspha gia grade prior to and after oesophageal stent placement was assessed and t he complications documented. Of the 17 patients, 16 reported an improvement in dysphagia. The mean dysphagia score improved from 3.1 prior to treatmen t to 1.3 after treatment. In 1 patient the stent slipped during placement a nd another stent was placed satisfactorily. Early complications (within 48 h) in the form of mild to moderate retrosternal chest pain occurred in 5 pa tients. This was treated symptomatically. Late complications (after 48 h) i n the form of bolus impaction occurred in 2 patients. This was successfully treated with oesophagoscopy and removal of bolus. In 2 patients with the s tent was overgrown by tumour and in one of these an additional stent was pl aced. In 1 patient incomplete closure of a tracheo-oesophageal fistula was observed. There was no procedure- or stent-related mortality. The mean surv ival time of this group was 2.1 months. Self-expanding metallic stents can be safely and effectively used in the palliation of dysphagia due to extern al mediastinal malignancies.