Endoscopy 1999; 31(6): 417-420
DOI: 10.1055/s-1999-43
Original Article
Georg Thieme Verlag Stuttgart ·New York

Esophacoil Expanding Stent in the Management of Patients with Nonresectable Malignant Esophageal or Cardiac Neoplasm: A Prospective Study

 E. Olsen,  R. Thyregaard,  J. Kill
  • Dept. of Surgery, Viborg Hospital, Viborg, Denmark
Further Information

Publication History

Publication Date:
31 December 1999 (online)

Introduction

Metallic self-expanding stents for palliative intubation of nonresectable malignant esophageal strictures provide an important improvement in the management of the frail and often elderly patients. The endoscopically guided insertion is facilitated by narrow introduction systems which need only minimal preliminary dilatation. The risk of perforation or rupture is minimized by the gradual expansion of the stent along the whole length [1] [2].

Covered stents are resistant to tumor ingrowth [3] [4]. The cover, however, can make the surface slippery, leading to a tendency for migration of the stent.

The Esophacoil is a biocompatible metal stent made from Nitinol. It consists of a long flat “memory” spiral wire which has a very strong self-expansion force. The latter, together with the tulip-shaped open coil fixation sections at each end, minimizes the risk of migration. The complete retraction of the spiral prevents tumor overgrowth, as with covered stents. It is flexible and adapts easily to angulated strictures (Figure [1]). The stent can be removed by pulling the wire through a protective stiffening tube applied over the gastroduodenoscope.

After release there is a 50 % shortening of the stent length; this must be taken into consideration during application, because after the first step in the three-step releasing procedure, repositioning is difficult.

References

  • 1 Cook T A, Dehn T CB. Use of covered expandable metal stents in the treatment of oesophageal carcinoma and tracheo-oesophageal fistula.  Br J Surg. 1996;  83 1417-1418
  • 2 Fugger R, Niederle B, Jantsch Hm et al. Endoscopic tube implantation for the palliation of malignant esophageal stenosis.  Endoscopy. 1990;  22 101-104
  • 3 Knyrim K, Wagner H J, Bethge N, et al. A controlled trial of an expansible metal stent for palliation of esophageal obstruction due to inoperability.  N Engl J Med. 1993;  329 1302-1307
  • 4 De Palma G D, di Matteo E, Romano G, et al. Plastic prosthesis versus expandable metal stents for palliation of inoperable esophageal thoracic carcinoma: a controlled prospective study.  Gastroinest Endosc. 1996;  43 478-482
  • 5 Segalin A, Bonavina L, Carazzone A, et al. Improving results of esophageal stenting: a study on 160 consecutive unselected patients.  Endoscopy. 1997;  29 701-709
  • 6 Loizou L A, Grigg D, Atkinson M, et al. A prospective comparison of laser therapy and intubation in the endoscopic palliation of malignant dysphagia.  Gastroenterology. 1991;  100 1301-1310
  • 7 Caspers R J, Welvaart K, Verkes R J, et al. The effect of radiotherapy on dysphagia and survival in patients with esophageal cancer.  Radiother Oncol. 1988;  12 15-23
  • 8 May A, Feess G, Bauer R, Ell C. Mucosal strangulation due to self-expanding coil stents.  Gastrointest Endosc. 1997;  46 273-276
  • 9 Segalin A, Bonavina L, Siardi C, et al. Can the expandable esophageal metal endocoil stent be safely removed?.  Endoscopy. 1997;  29 337-338
  • 10 Loser C, Folsch U R. Self-expanding metallic coil stents for palliation of esophageal carcinoma: two cases of decisive stent dysfunction.  Endoscopy. 1996;  28 514-517
  • 11 Ell C, May A. Self-expanding metal stents for palliation of stenosing tumors of the esophagus and cardia: a critical review.  Endoscopy. 1997;  29 392-398
  • 12 Song H Y, Do Y S, Han Y M, et al. Covered expandable esophageal metallic stent tubes: experiences in 119 patients.  Radiology. 1994;  193 689-695
  • 13 Kozarek R A, Raltz S R, Marcon N, et al. Use of the 25 mm flanged esophageal Z stent for malignant dysphagia: a prospective multicenter trial.  Gastrointest Endosc. 1997;  46 156-160
  • 14 Dorta G, Binek J, Blum A L, et al. Comparison between esophageal Wallstent and Ultraflex stents in the treatment of malignant stenosis of the esophagus and cardia.  Endoscopy. 1997;  29 149-154
  • 15 Nelson D B, Axelrad A M, Fleischer D E, et al. Silicone-covered Wallstent prototypes for palliation of malignant esophageal obstruction and digestive-respiratory fistulas.  Gastrointest Endosc. 1997;  45 31-37

E. OlsenM.D. 

Department of Surgery

Viborg Hospital

8800 Viborg

Denmark

Phone: + 45-8927-3481

Email: eyo@dadlnet.dk