PURPOSE: Placement of self-expanding metal stents is regarded as a safe and effective treatment in patients with incurable malignant esophagogastric obstruction. However, proceeding and possible benefit of re-interventions in patients with recurrent dysphagia due to delayed complications (>4 weeks after stent insertion) is unclear. PATIENTS AND METHODS: In 133 patients with malignant stricture of the esophagus or the esophagogastric junction 164 expandable metal stents were placed. About 89 patients were followed up until death. All tumor- or stent-related complications and consequent re-interventions were recorded. RESULTS: The overall incidence of delayed complications was 53.4% (71 of 133 pts.), with 34 patients (25.6%) experiencing more than one complication. Recurrent dysphagia due to tumor ingrowth (22%) or overgrowth (15%), bolus obstruction (21%), stent migration (9%), and development of esophagorespiratory fistula (9%) was successfully treated by dilatation (24%), placement of a second/third stent (27%), laser therapy (16%), and/or placement of a feeding tube (PEG, 19%). The median survival of patients with endoscopic therapy was significantly longer (222 +/- 26 days) compared to patients without re-intervention (86 +/- 14 days, P < 0.0001). CONCLUSIONS: Delayed complications after metal stent placement for malignant esophageal stricture are common, but can be treated successfully by endoscopic re-intervention in most cases. Regular interventional therapy may also improve survival.
PURPOSE: Placement of self-expanding metal stents is regarded as a safe and effective treatment in patients with incurable malignant esophagogastric obstruction. However, proceeding and possible benefit of re-interventions in patients with recurrent dysphagia due to delayed complications (>4 weeks after stent insertion) is unclear. PATIENTS AND METHODS: In 133 patients with malignant stricture of the esophagus or the esophagogastric junction 164 expandable metal stents were placed. About 89 patients were followed up until death. All tumor- or stent-related complications and consequent re-interventions were recorded. RESULTS: The overall incidence of delayed complications was 53.4% (71 of 133 pts.), with 34 patients (25.6%) experiencing more than one complication. Recurrent dysphagia due to tumor ingrowth (22%) or overgrowth (15%), bolus obstruction (21%), stent migration (9%), and development of esophagorespiratory fistula (9%) was successfully treated by dilatation (24%), placement of a second/third stent (27%), laser therapy (16%), and/or placement of a feeding tube (PEG, 19%). The median survival of patients with endoscopic therapy was significantly longer (222 +/- 26 days) compared to patients without re-intervention (86 +/- 14 days, P < 0.0001). CONCLUSIONS: Delayed complications after metal stent placement for malignant esophageal stricture are common, but can be treated successfully by endoscopic re-intervention in most cases. Regular interventional therapy may also improve survival.
Authors: P D Siersema; S L Schrauwen; M van Blankenstein; E W Steyerberg; A van der Gaast; H W Tilanus; J Dees Journal: Gastrointest Endosc Date: 2001-11 Impact factor: 9.427
Authors: Juliana Yang; Ali A Siddiqui; Thomas E Kowalski; David E Loren; Ammara Khalid; Ayesha Soomro; Syed M Mazhar; Julian Rosé; Laura Isby; Michel Kahaleh; Ankush Kalra; Alex M Sarkisian; Nikhil A Kumta; Jose Nieto; Reem Z Sharaiha Journal: Surg Endosc Date: 2016-08-05 Impact factor: 4.584
Authors: L M Almond; K Patel; L Keast; J Hodson; R Nijjar; P G Wilson; M Richardson; R Singhal Journal: Surg Endosc Date: 2016-09-09 Impact factor: 4.584
Authors: Stephen Kucera; James Barthel; Jason Klapman; Ravi Shridhar; Sarah Hoffe; Cynthia Harris; Khaldoun Almhanna; Kenneth Meredith Journal: J Gastrointest Oncol Date: 2016-06