R. Singhvi et al., Insertion of self-expanding metal stents for malignant dysphagia: assessment of a simple endoscopic method, ANN RC SURG, 82(4), 2000, pp. 243-248
Citations number
20
Categorie Soggetti
Surgery
Journal title
ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND
Aim: To assess the efficacy, safety and long-term results of self-expanding
metallic prostheses, placed using an entirely endoscopic method, for the r
elief of dysphagia in oesophageal carcinoma.
Patients and Methods: A consecutive series of 50 patients (30 men, 20 women
), aged 43-91 years (median, 75 years) underwent stent placement (Ultraflex
Stent, Boston Scientific, Watertown, MA, USA) under general anaesthesia wi
thout fluoroscopic control.
Results: Stent placement was successful in all patients. Swallowing improve
d from dysphagia score 4, 3 or 2 to score 1 (or 0) in all patients availabl
e for long-term follow-up (excluding two patients who died, and two who had
resection, in the immediate poststenting period). There were two early dea
ths that were, or could have been, procedure-related and one early complica
tion, in addition to technical problems in 6 cases, all early in the series
. Seven patients required endoscopic laser treatment, on 13 occasions, subs
equently for tumour in-growth or over-growth. Of the 46 patients with long-
term stents in situ, 36 patients died with a median survival time of 4 mont
hs (range 10 days to 24 months). At the time of writing, 10 patients are st
ill alive with a median survival of 4 months (range 1-11 months).
Conclusions: Self-expanding metallic stents provide rapid, safe and effecti
ve relief of dysphagia. They can provide long-term palliation (>1 year) wit
h endoscopic laser treatment for recurrent in-growing/over-growing tumour.
Fluoroscopic control is not necessary for the safe and accurate placement o
f such stents.