Self-expanding metal stents for endoscopic treatment of esophageal achalasia unresponsive to conventional treatments. Long-term results in eight patients

Background and Study Aims: The successful use of self expanding metal stent s has been demonstrated in the management of malignant esophagocardial stri ctures. This report assesses the role stents may play in the treatment of e sophageal achalasia in selected patients. Patients and Methods: Between September 1996 and December 1997, eight patie nts (two men, six women; average age 67.6 years) underwent insertion of a s elf-expanding metal stent for management of achalasia. Previous myotomy and /or balloon dilation or injection of botulinum toxin had failed in all pati ents. Four nitinol coil stents and five covered Ultraflex stents, 10 cm lon g, were inserted, being passed through the gastroesophageal junction under mild sedation. Results: Stent placement was successful and uncomplicated in all patients. Early complications were seen in five patients: chest pain (1), gastroesoph ageal reflux (1), proximal migration (1), and distal migration (2). One pat ient underwent surgery for stent impaction in the colon. During the follow- up period of 35.5 months, on average (range 29-44 months), four patients ex perienced complications: chest pain (2), reflux esophagitis (1) and stent m igration (1). Conclusion: General use of self expanding metal stents for esophageal achal asia cannot be recommended.