Self expanding metal stents in esophagogastric cancer

Background and aims. Dysphagia is the most common disabling symptom in patients with inoperable esophagogastric carcinoma. Self-expanding metal stents are highly effective in the palliation of these patients.Methods. In 35 patients with inoperable carcinoma of the esophagus or the stomach, with recurrent tumor or complications after transhiatal esophagectomy or gastrectomy or with esophageal stenosis caused by pulmonary cancer, a selfexpanding nitinol stent was placed to reduce dysphagia. Dysphagia and WHO performance status were assessed, before and after stent placement. Results. In 35 patients, 39 stents were placed without technical problems. Dysphagia improved significantly. The WHO performance status remained stable. Mean survival of all patients was 11 weeks. Major complications occurred in 3 patients. One patient died of massive tumor bleeding. Minor complications such as stent migration or retrosternal pain occurred in 5 patients. In 2 patients the migrated stent could successfully be placed in the correct position after giving ice-cooled water through the endoscope. Four patients had esophagorespiratory fistulas which were all initially successfully occluded. Conclusion. This nitinol stent is highly effective for improving dysphagia in patients with malignant esophagogastric obstruction. We observed no procedurerelated complications. Bleeding was the principal major complication. The early intake of cold beverages resulted in stent migration. Recurrent dysphagia due to overgrowth by tumor or nonmalignant tissue remains a problem. Technical improvements are desirable to reduce the overgrowth by nonmalignant tissue.