Insertion of self-expanding metal stents for malignant dysphagia: assessment of a simple endoscopic method

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.