Download PDF
CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2019; 10(02): 101-106
DOI: 10.1055/s-0039-1693508
Original Article
Society of Gastrointestinal Endoscopy of India

Efficacy and Safety of Endoscopic Self-Expanding Metallic Stent for Esophageal Malignancy: A Two-Institute Experience

Avinash Bhat Balekuduru
1   Department of Gastroenterology, Ramaiah Memorial Hospital, Bangalore, Karnataka, India
,
Manoj Kumar Sahu
2   Department of Gastroenterology and Hepatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
,
Kirti Koushik Agrahara Sreenivasa
3   Department of Radiotherapy, Ramaiah Memorial Hospital, Bangalore, Karnataka, India
,
Janaki Manur Gururajachar
3   Department of Radiotherapy, Ramaiah Memorial Hospital, Bangalore, Karnataka, India
,
Kiran Reddyvari
1   Department of Gastroenterology, Ramaiah Memorial Hospital, Bangalore, Karnataka, India
,
Satyaprakash Bonthala Subbaraj
1   Department of Gastroenterology, Ramaiah Memorial Hospital, Bangalore, Karnataka, India
› Author Affiliations
Further Information

Publication History

Publication Date:
07 August 2019 (online)

   Permissions and Reprints

Abstract

Background: Self-expandable metallic stents (SEMS) placement is the procedure of choice for palliation of dysphagia in inoperable esophageal malignancies.

Aim To evaluate the safety of placement of SEMS in esophageal cancer at two institutes using only endoscopic control without fluoroscopy and to determine efficacy of SEMS in palliation of dysphagia after deployment.

Methods: Participants who underwent endoscopy and esophageal SEMS placement at two centers for inoperable esophageal malignancy between 2014 and 2017 were included retrospectively. The indication for the procedure and clinical outcome measures like adverse events and improvement in dysphagia score were recorded on uniform structured data forms.

Results: Eighty-three esophageal SEMS placement was performed in 78 patients (mean age 64 ± 10.1 years; 59 men). The indication of SEMS placement was stricture in 72 (92.3%) and in 6 cases SEMS was placed for closure of trachea–esophageal fistula. All the patients in dysphagia score of 3 have improved to lower dysphagia scores post stent deployment. Postprocedure retrosternal pain, respiratory distress, and aspiration pneumonia in 58, 9, and 2 patients, respectively. Five patients required repeat stenting due to tumor ingrowth/granulation tissue during follow-up. The median survival of patients who received SEMS was significantly different from controls who did not receive SEMS (141 [41–360] days versus 98 [30–165 days]; p = 0.01). In 2 cases stent repositioning was done due to distal migration at the time of placement. There was no SEMS migration or stent related complications at follow-up.

Conclusions: SEMS can be placed effectively under endoscopic control without fluoroscopic control in palliation of esophageal malignancy. Early SEMS deployment for palliating dysphagia may lead to survival advantage.

Keywords

controlled radial expansile dilation - esophageal malignancy - self-expanding metallic stent
 

  • References

  • 1 Herszényi L, Tulassay Z. Epidemiology of gastrointestinal and liver tumors. Eur Rev Med Pharmacol Sci 2010; 14 (04) 249-258
    PubMedGoogle Scholar
  • 2 Eslick GD. Epidemiology of esophageal cancer. Gastroenterol Clin North Am 2009; 38 (01) 17-25 , vii
    CrossrefPubMedGoogle Scholar
  • 3 Weigel TL, Frumiento C, Gaumintz E. Endoluminal palliation for dysphagia secondary to esophageal carcinoma. Surg Clin North Am 2002; 82 (04) 747-761
    CrossrefPubMedGoogle Scholar
  • 4 Brierley JD, Oza AM. Radiation and chemotherapy in the management of malignant esophageal strictures. Gastrointest Endosc Clin N Am 1998; 8 (02) 451-463
    CrossrefPubMedGoogle Scholar
  • 5 Pennathur A, Gibson MK, Jobe BA, Luketich JD. Oesophageal carcinoma. Lancet 2013; 381 (9864): 400-412
    CrossrefPubMedGoogle Scholar
  • 6 Ferreira F, Bastos P, Ribeiro A. et al. A comparative study between fluoroscopic and endoscopic guidance in palliative esophageal stent placement. Dis Esophagus 2012; 25 (07) 608-613
    CrossrefPubMedGoogle Scholar
  • 7 Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine 2002; 27 (22) 2453-2458
    CrossrefPubMedGoogle Scholar
  • 8 Egan JV, Baron TH, Adler DG. et al; Standards of Practice Committee. Esophageal dilation. Gastrointest Endosc 2006; 63 (06) 755-760
    CrossrefPubMedGoogle Scholar
  • 9 Bethge N, Sommer A, von Kleist D, Vakil N. A prospective trial of self-expanding metal stents in the palliation of malignant esophageal obstruction after failure of primary curative therapy. Gastrointest Endosc 1996; 44 (03) 283-286
    CrossrefPubMedGoogle Scholar
  • 10 Dobrucali A, Caglar E. Palliation of malignant esophageal obstruction and fistulas with self-expandable metallic stents. World J Gastroenterol 2010; 16 (45) 5739-5745
    CrossrefPubMedGoogle Scholar
  • 11 Adam A, Ellul J, Watkinson AF. et al. Palliation of inoperable esophageal carcinoma: a prospective randomized trial of laser therapy and stent placement. Radiology 1997; 202 (02) 344-348
    CrossrefPubMedGoogle Scholar
  • 12 White RE, Mungatana C, Topazian M. Esophageal stent placement without fluoroscopy. Gastrointest Endosc 2001; 53 (03) 348-351
    CrossrefPubMedGoogle Scholar
  • 13 Raijman I, Siddique I, Ajani J, Lynch P. Palliation of malignant dysphagia and fistulae with coated expandable metal stents: experience with 101 patients. Gastrointest Endosc 1998; 48 (02) 172-179
    CrossrefPubMedGoogle Scholar
  • 14 Ahmad NR, Goosenberg EB, Frucht H, Coia LR. Palliative treatment of esophageal cancer. Semin. Radiat Oncol 1994; 4 (03) 202-214
    Google Scholar
  • 15 Saranovic Dj, Djuric-Stefanovic A, Ivanovic A, Masulovic D, Pesko P. Fluoroscopically guided insertion of self-expandable metal esophageal stents for palliative treatment of patients with malignant stenosis of esophagus and cardia: comparison of uncovered and covered stent types. Dis Esophagus 2005; 18 (04) 230-238
    CrossrefPubMedGoogle Scholar
  • 16 Acunas B, Rozanes I, Sayi I. et al. Treatment of malignant dysphagia with nitinol stents. Eur Radiol 1995; 5: 599-602
    Google Scholar
  • 17 Cwikiel W, Stridbeck H, Tranberg KG. et al. Malignant esophageal strictures: treatment with a self-expanding nitinol stent. Radiology 1993; 187 (03) 661-665
    CrossrefPubMedGoogle Scholar
  • 18 Song HY, Choi KC, Cho BH, Ahn DS, Kim KS. Esophagogastric neoplasms: palliation with a modified gianturco stent. Radiology 1991; 180 (02) 349-354
    CrossrefPubMedGoogle Scholar
  • 19 Raijman I, Lynch P. Coated expandable esophageal stents in the treatment of digestive-respiratory fistulas. Am J Gastroenterol 1997; 92 (12) 2188-2191
    PubMedGoogle Scholar
  • 20 Rahmani EY, Rex DK, Lehman GA. Z-stent for malignant esophageal obstruction. Gastrointest Endosc Clin N Am 1999; 9 (03) 395-402
    CrossrefPubMedGoogle Scholar
  • 21 Wong K, Goldstraw P. Role of covered esophageal stents in malignant esophagorespiratory fistula. Ann Thorac Surg 1995; 60 (01) 199-200
    CrossrefPubMedGoogle Scholar
  • 22 Roy-Choudhury SH, Nicholson AA, Wedgwood KR. et al. Symptomatic malignant gastroesophageal anastomotic leak: management with covered metallic esophageal stents. AJR Am J Roentgenol 2001; 176 (01) 161-165
    CrossrefPubMedGoogle Scholar
  • 23 Ramirez FC, Dennert B, Zierer ST, Sanowski RA. Esophageal self-expandable metallic stents–indications, practice, techniques, and complications: results of a national survey. Gastrointest Endosc 1997; 45 (05) 360-364
    CrossrefPubMedGoogle Scholar
  • 24 Muto M, Ohtsu A, Miyata Y, Shioyama Y, Boku N, Yoshida S. Self-expandable metallic stents for patients with recurrent esophageal carcinoma after failure of primary chemoradiotherapy. Jpn J Clin Oncol 2001; 31 (06) 270-274
    CrossrefPubMedGoogle Scholar
  • 25 Knyrim K, Wagner HJ, Bethge N, Keymling M, Vakil N. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med 1993; 329 (18) 1302-1307
    CrossrefPubMedGoogle Scholar
  • 26 De Palma GD, di Matteo E, Romano G, Fimmano A, Rondinone G, Catanzano C. Plastic prosthesis versus expandable metal stents for palliation of inoperable esophageal thoracic carcinoma: a controlled prospective study. Gastrointest Endosc 1996; 43 (05) 478-482
    CrossrefPubMedGoogle Scholar
  • 27 Kozarek RA, Ball TJ, Brandabur JJ. et al. Expandable versus conventional esophageal prostheses: easier insertion may not preclude subsequent stent-related problems. Gastrointest Endosc 1996; 43 (03) 204-208
    CrossrefPubMedGoogle Scholar
  • 28 Bartelsman JF, Bruno MJ, Jensema AJ, Haringsma J, Reeders JW, Tytgat GN. Palliation of patients with esophagogastric neoplasms by insertion of a covered expandable modified Gianturco-Z endoprosthesis: experiences in 153 patients. Gastrointest Endosc 2000; 51 (02) 134-138
    CrossrefPubMedGoogle Scholar