Malignant esophagogastric junction obstruction: Palliative treatment with an antireflux valve stent

The authors assessed the efficacy of an antireflux valve stent in the palli ation of malignant esophagogastric junction (EGJ) obstruction after in vitr o testing of the stent. Seventeen patients with inoperable malignant EGJ ob struction were treated. Antireflux valves, made of three polyurethane leafl ets, were attached to the distal part of the stent to prevent reflux. When the flow rate of normal saline was 100 mL/sec in the forward direction, the valve fully opened at a pressure of 10 mm Hg. When the flow rate of normal saline was 0.35 mL/sec in the backward direction, the valve nearly complet ely closed at a pressure of 10 mm Hg. Stent placement was successful in all patients without complications. The median dysphagia score decreased signi ficantly, from 3.0 (dysphagia to liquids) to 1.0 (dysphagia to normal solid food) (P < .0005). No patients experienced reflux symptoms. There was one case of stent migration. A valve stent that can prevent major reflux is an effective device for the palliation of malignant EGJ obstruction.