SELF‐EXPANDABLE METAL STENTS FOR MALIGNANT DYSPHAGIA

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Abstract
Background: The use of self‐expandable metal stents in relieving dysphagia for patients with incurable malignant oesophageal strictures was retrospectively evaluated. Methods: Between September 1993 and August 1996, 66 male and 16 female patients with a median age of 72 years received self‐expandable metal stents for malignant dysphagia. Six patients had concurrent tracheo‐oesophageal fistulas. All patients were stented under sedation and stent insertion was performed under fluoroscopic guidance. Results: Stent placement was successful in 80 patients (98%). There were seven early complications (inaccurate positioning (n = 3), migration (n = 1), incomplete expansion (n = 1), intractable pain (n = 1), and perforation (n = 1)). Two complications were lethal and three were treated endoscopically. Mean dysphagia grade improved from 3.2 ± 0.7 to 1.8 ± 0.9 (P < 0.05) after implantation. All tracheo‐esophageal fistulas were successfully occluded. Upon a median follow‐up of 8 weeks (range: 2–20 weeks), 30 complications developed in 21 patients (tumour overgrowth (n = 15), food bolus obstruction (n = 7), tumour ingrowth (n = 2), buckling of stent (n = 2), tracheo‐esophageal fistula (n = 2), bleeding (n = 1), and gastric wall herniation through metal coils (n = 1)). Median survival was 13 weeks (range: 1–82 weeks). Conclusion: Self‐expandable metal stents provide useful palliation in patients with incurable malignant dysphagia.