Treatment of malignant esophageal stricture and tracheo-esophageal fistula with self-expanding metal stents

F. A. Rochling, K. Dua, K. Saeian, A. G. Bohorfoush, R. Shaker

Research output: Contribution to journalArticle

Abstract

Self-expanding metal stents (SEMS) are now being increasingly used in palliation of malignant esophageal obstruction and tracheo-esophageal fistula (TEF). The aim of this study was to review our experience with the new generation of SEMS in management of patients who had failed other treatment modalities of palliation. Patients & Methods: Between 8/94 and 8/96 14 patients (12 male; age 68 range 47-81) were referred for palliation of dysphagia (13) and/or TEF (3) after other modalities (surgery, chemotherapy, radiotherapy) of palliation had failed. A total of 17 SEMS were deployed: 3 Ultraflex (Microvasive), 3 Wallstent (Schneider), 5 EsophagoCoil (Instent), 6 EZS (Wilson-Cook). Pre-insertion dilatations were performed (diameter:44±5F) to allow adequate stent expansion after deployment. Palliation was assessed by dysphagia score (0: normal, to 4: inability to swallow saliva) and alleviation of TEF symptoms; then corroborated by esophagogram done within 24 hrs in all patients. Results: SEMS were successfully placed in all patients. In 12/14 patients the dysphagia was immediately relieved as documented by esophagogram and a significant decrease in dysphagia score from 3.5±0.2SE to 1.4±0.2 (p<0.001). In one patient (proximal esophageal stricture with laser-induced TEF) dysphagia could not be relieved as the proximal extent of the stricture was near the UES. However, the stent successfully bridged the TEF. In another patient post-deployment dysphagia relief was not seen as the stent had migrated proximally. Successful palliation of TEF was immediately achieved in all patients using covered stents. Three patients returned within a mean of 31 days (range:1-38) with recurrent symptoms secondary to stent migration (1), overgrowth (1) and TEF (1). In these patients additional SEMS were placed and symptoms successfully palliated. Continued intractable chest pain in one patient necessitated removal of the EsophagoCoil stent. Two patients (gastroesophageal junction cancer with trans-GEJ stent placement) required continued therapy with a proton-pump inhibitor to alleviate reflux symptoms. Conclusion: SEMS provide safe, immediate and effective palliation of malignant esophageal obstruction and TEF in the majority of patients.

Original languageEnglish (US)
Pages (from-to)AB80
JournalGastrointestinal Endoscopy
Volume45
Issue number4
DOIs
StatePublished - Jan 1 1997

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Esophageal Fistula
Esophageal Stenosis
Stents
Metals
Deglutition Disorders
Therapeutics
Esophagogastric Junction
Intractable Pain
Proton Pump Inhibitors
Deglutition
Chest Pain
Saliva

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Treatment of malignant esophageal stricture and tracheo-esophageal fistula with self-expanding metal stents. / Rochling, F. A.; Dua, K.; Saeian, K.; Bohorfoush, A. G.; Shaker, R.

In: Gastrointestinal Endoscopy, Vol. 45, No. 4, 01.01.1997, p. AB80.

Research output: Contribution to journalArticle

Rochling, F. A. ; Dua, K. ; Saeian, K. ; Bohorfoush, A. G. ; Shaker, R. / Treatment of malignant esophageal stricture and tracheo-esophageal fistula with self-expanding metal stents. In: Gastrointestinal Endoscopy. 1997 ; Vol. 45, No. 4. pp. AB80.
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abstract = "Self-expanding metal stents (SEMS) are now being increasingly used in palliation of malignant esophageal obstruction and tracheo-esophageal fistula (TEF). The aim of this study was to review our experience with the new generation of SEMS in management of patients who had failed other treatment modalities of palliation. Patients & Methods: Between 8/94 and 8/96 14 patients (12 male; age 68 range 47-81) were referred for palliation of dysphagia (13) and/or TEF (3) after other modalities (surgery, chemotherapy, radiotherapy) of palliation had failed. A total of 17 SEMS were deployed: 3 Ultraflex (Microvasive), 3 Wallstent (Schneider), 5 EsophagoCoil (Instent), 6 EZS (Wilson-Cook). Pre-insertion dilatations were performed (diameter:44±5F) to allow adequate stent expansion after deployment. Palliation was assessed by dysphagia score (0: normal, to 4: inability to swallow saliva) and alleviation of TEF symptoms; then corroborated by esophagogram done within 24 hrs in all patients. Results: SEMS were successfully placed in all patients. In 12/14 patients the dysphagia was immediately relieved as documented by esophagogram and a significant decrease in dysphagia score from 3.5±0.2SE to 1.4±0.2 (p<0.001). In one patient (proximal esophageal stricture with laser-induced TEF) dysphagia could not be relieved as the proximal extent of the stricture was near the UES. However, the stent successfully bridged the TEF. In another patient post-deployment dysphagia relief was not seen as the stent had migrated proximally. Successful palliation of TEF was immediately achieved in all patients using covered stents. Three patients returned within a mean of 31 days (range:1-38) with recurrent symptoms secondary to stent migration (1), overgrowth (1) and TEF (1). In these patients additional SEMS were placed and symptoms successfully palliated. Continued intractable chest pain in one patient necessitated removal of the EsophagoCoil stent. Two patients (gastroesophageal junction cancer with trans-GEJ stent placement) required continued therapy with a proton-pump inhibitor to alleviate reflux symptoms. Conclusion: SEMS provide safe, immediate and effective palliation of malignant esophageal obstruction and TEF in the majority of patients.",
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AU - Dua, K.

AU - Saeian, K.

AU - Bohorfoush, A. G.

AU - Shaker, R.

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N2 - Self-expanding metal stents (SEMS) are now being increasingly used in palliation of malignant esophageal obstruction and tracheo-esophageal fistula (TEF). The aim of this study was to review our experience with the new generation of SEMS in management of patients who had failed other treatment modalities of palliation. Patients & Methods: Between 8/94 and 8/96 14 patients (12 male; age 68 range 47-81) were referred for palliation of dysphagia (13) and/or TEF (3) after other modalities (surgery, chemotherapy, radiotherapy) of palliation had failed. A total of 17 SEMS were deployed: 3 Ultraflex (Microvasive), 3 Wallstent (Schneider), 5 EsophagoCoil (Instent), 6 EZS (Wilson-Cook). Pre-insertion dilatations were performed (diameter:44±5F) to allow adequate stent expansion after deployment. Palliation was assessed by dysphagia score (0: normal, to 4: inability to swallow saliva) and alleviation of TEF symptoms; then corroborated by esophagogram done within 24 hrs in all patients. Results: SEMS were successfully placed in all patients. In 12/14 patients the dysphagia was immediately relieved as documented by esophagogram and a significant decrease in dysphagia score from 3.5±0.2SE to 1.4±0.2 (p<0.001). In one patient (proximal esophageal stricture with laser-induced TEF) dysphagia could not be relieved as the proximal extent of the stricture was near the UES. However, the stent successfully bridged the TEF. In another patient post-deployment dysphagia relief was not seen as the stent had migrated proximally. Successful palliation of TEF was immediately achieved in all patients using covered stents. Three patients returned within a mean of 31 days (range:1-38) with recurrent symptoms secondary to stent migration (1), overgrowth (1) and TEF (1). In these patients additional SEMS were placed and symptoms successfully palliated. Continued intractable chest pain in one patient necessitated removal of the EsophagoCoil stent. Two patients (gastroesophageal junction cancer with trans-GEJ stent placement) required continued therapy with a proton-pump inhibitor to alleviate reflux symptoms. Conclusion: SEMS provide safe, immediate and effective palliation of malignant esophageal obstruction and TEF in the majority of patients.

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