Self-expanding segmental radioactive metal stents for palliation of malignant esophageal strictures

Abstract

Background

Traditional metal stents are not always suitable for patients with circuitous malignant esophageal stricture.

Purpose

We aimed to report the safety and effectiveness of stent insertion using self-expanding segmental radioactive metal stent in the palliation of malignant esophageal stricture.

Material and Methods

We conducted a retrospective analysis of 22 consecutive patients who underwent insertion of segmental radioactive metal stents from November 2016 to March 2019. Technical success, dysphagia score, and complications were analyzed. Kaplan–Meier analysis was used to analyze the survival time.

Results

The stenting procedure was successful in all 22 patients with no procedure-related deaths. Twenty-four segmental radioactive metal stents were successfully implanted. A total of 6 (27.3%) complications were found, mainly 5 (22.7%) stent migrations. The median follow-up period was 3.3 months. Stent removal was required in 4 (12.5%) patients due to complete stent migration. The mean dysphagia score decreased significantly after stent insertion (P<0.0001). During follow up, 13 patients survived with no obvious clinical symptom and nine patients died. The mean survival was 9.9 months.

Conclusion

The stenting procedure using self-expanding segmental radioactive metal stents is safe and effective in dysphagia palliation of malignant esophageal stricture.

Keywords

Dysphagia esophageal stricture intraluminal radioactive stent self-expanding metal stent

Get full access to this article

View all access options for this article.

References

Sundelof

Dickman

, et al. Improved survival in both histologic types of oesophageal cancer in Sweden. Int J Cancer 2002; 99:751–754.

Kubba

Krasner

An update in the palliative management of malignant dysphagia.

Eur J Surg Oncol 2000; 26:116–129.

Bethge

Sommer

von Kleist

, et al. A prospective trial of self-expanding metal stents in the palliation of malignant esophageal obstruction after failure of primary curative therapy. Gastrointest Endosc 1996; 44:283–286.

Baron

TH.

Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract.

N Engl J Med 2001; 344:1681–1687.

Conio

Repici

Battaglia

, et al. A randomized prospective comparison of self-expandable plastic stents and partially covered self-expandable metal stents in the palliation of malignant esophageal dysphagia. Am J Gastroenterol 2007; 102:2667–2677.

Bona

Sarli

Saino

, et al. Successful conservative management of benign gastro-bronchial fistula after intrathoracic esophagogastrostomy. Ann Thorac Surg 2007; 84:1036–1038.

Wlodarczyk

Kuzdzal

Stenting in palliation of unresectable esophageal cancer.

World J Surg 2018; 42:3988–3996.

Riccioni

Shah

Tringali

, et al. Endoscopic palliation of unresectable malignant oesophageal strictures with self-expanding metal stents: comparing Ultraflex and Esophacoil stents. Dig Liver Dis 2002; 34:356–363.

Nathwani

Kowalski

Endoscopic stenting of esophageal cancer: the clinical impact.

Curr Opin Gastroenterol 2007; 23:535–538.

10.

Tian

Wen

Comparative study of self-expanding metal stent and intraluminal radioactive stent for inoperable esophageal squamous cell carcinoma.

World J Surg Oncol 2016; 14:18.

11.

Zhongmin

Xunbo

Jun

, et al. Intraluminal radioactive stent compared with covered stent alone for the treatment of malignant esophageal stricture. Cardiovasc Intervent Radiol 2012; 35:351–358.

12.

Guo

Teng

Zhu

, et al. Self-expandable esophageal stent loaded with 125I seeds: initial experience in patients with advanced esophageal cancer. Radiology 2008; 247:574–581.

13.

Roy-Choudhury

Nicholson

Wedgwood

, et al. Symptomatic malignant gastroesophageal anastomotic leak: management with covered metallic esophageal stents. AJR Am J Roentgenol 2001; 176:161–165.

14.

Baron

TH.

A practical guide for choosing an expandable metal stent for GI malignancies: is a stent by any other name still a stent?

Gastrointest Endosc 2001; 54:269–272.

15.

Mayoral

Fleischer

Salcedo

, et al. Nonmalignant obstruction is a common problem with metal stents in the treatment of esophageal cancer. Gastrointest Endosc 2000; 51:556–559.

16.

Bethge

Vakil

A prospective trial of a new self-expanding plastic stent for malignant esophageal obstruction.

Am J Gastroenterol 2001; 96:1350–1354.

17.

Dormann

Eisendrath

Wigginghaus

, et al. Palliation of esophageal carcinoma with a new self-expanding plastic stent. Endoscopy 2003; 35:207–211.

18.

Ross

Alkassab

Lynch

, et al. Evolving role of self-expanding metal stents in the treatment of malignant dysphagia and fistulas. Gastrointest Endosc 2007; 65:70–76.

19.

Bona

Laface

Siboni

, et al. [Self-expanding oesophageal stents: comparison of Ultraflex and Choostent]. Chir Ital 2009; 61:641–646.

20.

Christie

Buenaventura

Fernando

, et al. Results of expandable metal stents for malignant esophageal obstruction in 100 patients: short-term and long-term follow-up. Ann Thorac Surg 2001; 71:1797–1801.

21.

Elphick

Smith

Bagshaw

, et al. Self-expanding metal stents in the palliation of malignant dysphagia: outcome analysis in 100 consecutive patients. Dis Esophagus 2005; 18:93–95.