Results of expandable metal stents for malignant esophageal obstruction in100 patients: Short-term and long-term follow-up

Background. Expandable metal stents palliate malignant dysphagia in most ca ses, but early complications and outcomes in long-term survivors have not b een well described. This report summarizes our experience with expandable m etal stents for malignant dysphagia. Methods. Over a 48-month period, 127 stents were placed in 100 patients wit h dysphagia from esophageal cancer (93%) or lung cancer. Most had undergone prior treatment. Dysphagia scores, duration of palliation, complications, and reintervention were evaluated. Results. Immediate improvement in dysphagia was observed in 85% of patients with no procedure-related deaths. Dysphagia score decreased from 3.3 befor e stent to 2.3 (p < 0.005). Average interval to reintervention was 80 days. In 40 patients surviving more than 120 days, 31 (78%) required reintervent ion. Major complications occurred in 3 patients receiving poststent chemora diation (tracheoesophageal fistula, T1 vertebral body abscess, mediastinal abscess). Other complications included unsatisfactory deployment requiring immediate removal (3 patients), migration (11 patients), pain requiring rem oval (2 patients), food impaction (10 patients), and tumor ingrowth (37 pat ients). Conclusions. Expandable metal stents offer excellent short-term palliation of malignant dysphagia. In long-term survivors, recurrent dysphagia requiri ng reintervention is common. In a small subset of patients receiving chemor adiation after stent placement, major complications were observed.