Patient tolerance of cervical esophageal metallic stents

PURPOSE: To demonstrate that proximal esophageal stenoses and tracheoesopha geal fistulas can be adequately palliated with use of metallic stents witho ut significant foreign-body sensation. MATERIALS AND METHODS: Between June 1994 and March 1999, 22 patients with l esions within 3 cm of the cricopharyngeus were treated by placement of meta llic stents, The series was reviewed retrospectively. Twenty patients had s urgically unresectable malignant lesions, two patients had benign disease. Ten patients had associated tracheoesophageal fistulas, In all, the upper l imit of the stent was between C5 vertebral body inferior endplate and the T 2 vertebral body superior endplate. The case-notes were reviewed until pati ent death (range, 6-198 days), or to date in the two surviving patients wit h benign disease. RESULTS: Immediate technical success was 93% (27 of 29), Dysphagia scores i mproved from a median of 3 to 2 after stent placement. Eighteen of 22 (82%) patients reported no foreign-body sensation. There have been no cases of p roximal migration, periprocedural perforation, or deaths. The two patients with benign disease experienced significant complications. CONCLUSION: Lesions in proximity to the cricopharyngeus can be successfully palliated without significant foreign-body sensation in the majority of pa tients with use of metallic stents, The authors urge caution in placing ste nts in patients with benign disease.