PHOTODYNAMIC THERAPY FOR THE TREATMENT OF TUMOR INGROWTH IN EXPANDABLE ESOPHAGEAL STENTS

Background and Study Aims: Tumor ingrowth through self-expanding metal stents presents a difficult problem for management. The techniques fo r treating tumor ingrowth have not yet been well described, and the op timal endoscopic approach is not clear. We have recently used photodyn amic therapy (PDT) to treat tumor ingrowth through uncovered nitinol m esh stents. Patients and Methods: Four patients (mean age 73) with obs tructive adenocarcinomas of the distal esophagus had received self-exp anding stents for palliation of their dysphagia. After stent placement , tumor ingrowth had caused progressive dysphagia in all of the patien ts; the dysphagia was graded on a scale from 0 (normal) to 4 (inabilit y to swallow liquids). All of the patients received PDT treatment. Res ults: After PDT, excellent palliation of the dysphagia was seen in all of the patients, with a mean improvement in the dysphagia score of 2. 25 and a mean dysphagia-free interval of 92 days. There were no major complications. Conclusion: The use of PDT to treat tumor ingrowth thro ugh self-expanding metal esophageal stents is effective and safe.