The palliation of dysphagia secondary to esophageal-cardial carcinoma with self-expandable metal prostheses. The authors' personal experience with 92 patients]

BACKGROUND: Endoscopic insertion of a stent is an important option in the palliative management of esophageal obstruction and esophagorespiratory fistula. Plastic stents have been available for over 20 years. A new class of self-expanding metal stents for palliation of esophageal and cardial cancer is now available. METHODS: Between September 1992 and October 1997, 92 patients underwent implantation of self-expanding metal stents for palliation of dysphagia due to inoperable esophageal or cardial cancer (65 patients) or for locally recurrent carcinoma after surgery (12 patients), laser-therapy (11 patients) or radiotherapy (4 patients). RESULTS: Successful stent implantation was achieved in 89/92 patients (96.7%). After stent implantation the dysphagia score improved from 3.0, on average, to 0.5, on average. Early complications were observed in 4.5% and peroperative mortality was 2.1%. Late complications were observed in 25.6%, with a mortality rate of 1.1%. The mean survival time was 6.9 months. CONCLUSIONS: Self-expanding metal stents are a new effective alternative for palliation of dysphagia due to esophageal and cardial cancers.     

Self-expandable metal stents for malignant dysphagia.

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.     

Our experience with the use of a plastic prosthesis and self-expanding stents in the palliative treatment of malignant neoplastic stenoses of the esophagus and cardia. Comparative analysis of results

Rapid palliation of malignant dysphagia is usually possible by means of the endoscopic implantation of a plastic prosthesis, but this device has a high morbidity rate. Recently, expandable metal stents have become available and may reduce the morbidity and mortality rates. The aim of this retrospective study was to evaluate self-expanding metal stents compared with conventional plastic prosthesis in malignant strictures of the oesophagus and cardia. One hundred and thirteen endoscopic tube implantations were carried out in 120 patients with malignant stenosis of the oesophagus and cardia using a plastic prosthesis over the period 1980-1993 (72 cases) and self-expanding metal stents over the period 1993-2001 (48 cases). The underlying causes of strictures were oesophageal or cardial cancer in 108 cases and oesophageal invasion by lung cancer in 12. The indications for endoscopic intubation were advanced tumour stage and/or risk factors which made resection inadvisable. The stents used in the conventional group were the Celestin pulsion tube in 18, the Atkinson prosthesis in 23 and the Wilson-Cook tube in 27, while the Ultraflex stent was always employed in the other group. Dysphagia was scored according to the Atkinson and Ferguson classification and the preoperative median score (3.6) was comparable in the two groups. The technical success rate was 94.4% with the plastic prosthesis (68/72) and 93.7% with the self-expanding metal stents (45/48) because in 4 and 3 patients, respectively, it proved impossible to implant the stent. After intubation the dysphagia score was improved in both groups (median score = 0.9) and the functional success rates were 85.2% (58/68) and 88.8% (40/45), respectively, while 10 and 5 patients showed no improvement of symptoms. The early complication rate was 5.9% (4/68) in the conventional stent group (1 perforation, 2 severe bleedings and 1 stent proximal migration) and nil in the other group. Late complications occurred in 14 (20.6%) (7 food obstruction, 4 neoplastic obstructions and 3 dislodgements) and 9 patients (20%) (3 neoplastic obstructions, 1 food obstruction, 3 distal migrations and 2 bleedings), respectively, but all the complications were easily corrected. Three deaths occurred with the plastic prosthesis (4.4%), while the mortality was nil with the metal stents. The median survival times were 183 (range: 58-486) and 151 days (range; 25-545), respectively. Our experience suggests that endoscopic placement of self-expanding metal stents is effective and safe for the management of dysphagia in malignant strictures of the oesophagus and cardia and has to be preferred to conventional plastic prostheses for easier implantation. The technical and functional success rates are similar in both groups, but the acute complication and mortality rates of the Ultraflex prosthesis are lower as compared to the traditional prosthesis.     

Self-expanding esophageal metallic stents in the treatment of esophageal obstruction

Esophageal obstruction from any cause is debilitating. In patients with malignant obstruction palliation to relieve pain and dysphagia is the primary goal. Conventional endoluminal prostheses allow variable palliation. Covered expandable metallic stents with an 18-mm lumen allow improved deglutition. From December 1994 through December 1998, 59 patients underwent placement of self-expanding silicone-covered esophageal stents for esophageal obstruction. There were 36 men and 23 women ranging in age from 41 to 94. All patients underwent esophageal dilation using a flexible gastroscope and Savary bougies. After dilation placement of the stent was performed under fluoroscopic control. Follow-up was complete in all patients. Technical success was achieved in all patients. There was one postoperative death (bronchopulmonary fistula), one migration of the stent requiring removal, and one recurrent obstruction. The remaining stents were well tolerated even in the cervical region (four patients). All patients returned to a diet of solid foods. We conclude that covered self-expanding esophageal metallic stents are technically simple and safe to insert and appear to provide durable excellent palliation of esophageal obstruction due to either benign or malignant conditions.     

Airway stenting.

Various airway pathologies may result in central airway obstruction. For patients who have benign and malignant disease, definitive surgical correction by tracheobronchial resection and reconstruction is preferred. Numerous patients, however, have unresectable airway lesions owing to the extent of disease or to medical or surgical contraindications. These patients can be palliated by several endoscopic strategies, including dilatation, core out of tumor, laser resection, endobronchial brachytherapy, or photodynamic therapy. Airway stenting with silicone or expandable metal stents provides reliable and durable palliation in 80% to 95% of properly selected patients. The major advantages of silicone stents are the ease of customization, repositioning, and removal, with the major drawbacks being stent migration or stent obstruction. Expandable metal stents have the advantage of ease of insertion, conformation to the airway, low inner-to-outer diameter ratio, and stent stability. These advantages, however, are offset by (1) the development of tumor ingrowth or of granulation at the end of the stent or through the interstices of the stent and (2) the difficulty or impossibility of stent repositioning or removal once it has been seated completely within the airway. Management of the patient who has central airway obstruction requires a thorough knowledge and consideration of the surgical and endoscopic management options and, usually, a multidisciplinary approach, with experienced thoracic surgical consultation to evaluate the potential for definitive surgical correction. The interventional bronchoscopist must consider the spectrum of endoscopic therapeutics fully. Most patients benefit from combining strategies in a flexible algorithm directed at optimizing patient outcomes. The benefits and risks of airway stenting must be considered in comparison with the other options for airway palliation. In refractory strictures, rapidly recurrent tumor, or extrinsic compression, endobronchial stenting likely will be necessary to achieve durable palliation of airway obstruction. The short- and long-term implications of airway stenting, including the complications of silicone versus expandable metal stents, should be considered thoroughly, while the physician bases treatment or procedure decisions on individual patient anatomy and expected natural history.     

Photodynamic therapy as palliation for esophageal cancer: experience in 215 patients

BACKGROUND: Photodynamic therapy (PDT) utilizes a photosensitizing agent, light, and oxygen to endoscopically ablate cancer cells. This review summarizes our experience with PDT for the palliation of bleeding or obstructing esophageal cancer (EC). METHODS: All patients with bleeding or obstructing EC treated with PDT from November 1996 through June 2002, were reviewed. After Photofrin II injection, nonthermal light treatment was delivered endoscopically. Dysphagia scores, duration of palliation, reinterventions, complications, and survival after treatment were reviewed. RESULTS: A total of 215 patients underwent 318 courses of PDT for bleeding (n = 15), obstruction (n = 277), bleeding and obstruction (n = 18), or other indications (n = 8). Tumor histology included 179 adenocarcinomas, 33 squamous cell carcinomas, and 3 undifferentiated. Seventy-five percent of EC were in the distal esophagus. In 85% of courses for obstruction, mean dysphagia scores improved pre- and post-PDT. The mean dysphagia-free interval was 66 days. Supplemental nutrition was discontinued after PDT in 8 of 27 patients (30%). Thirty-five patients required stent placement after PDT with a mean interval to reintervention of 58.5 days. PDT complications included perforation (2% of treatment courses), stricture (2%), Candida esophagitis (2%), pleural effusions (4%), and sunburn (6%). The procedure-related mortality rate was 1.8%, and median survival was 4.8 months. CONCLUSIONS: PDT offers effective palliation for patients with obstructing EC in 85% of treatment courses. The ideal EC patient for PDT palliation has an obstructing endoluminal cancer. Patients living more than 2 months may require reintervention to maintain palliation of malignant dysphagia, and a multimodality treatment approach is common.     

Metallstents in der Gastroenterologie

Self-expanding metal stents have, when introduced in their constrained form through gastrointestinal and biliary strictures, a relatively small diameter. Once placed through the stricture and released, however, they expand to a much larger internal diameter, thus giving rise to sufficient palliative reopening of these strictures. Since metal stents are usually not removable, their primary use has been in malignant stenoses. Benign strictures should be treated with metal stents only in exceptional situations. For palliation of dysphagia in esophagocardial malignancies, metal stents have been shown to be associated with significantly fewer initial complications on placement than plastic tubes. The long-term fate of both stent types seems to be similar. In the palliation of malignant jaundice, metal stents were demonstrated to have a significantly longer patency rate, resulting in a favourable cost-benefit ratio despite the high price of metal stents. Continued developments are necessary to further reduce long-term complications and effectiveness.     

Airway obstruction complicating esophageal stent placement in two post-pneumonectomy patients

Expandable metallic stents have been used effectively to treat multiple nonsurgical esophageal conditions. Here we describe two cases in postpneumonectomy patients in which expandable esophageal stent placement resulted in respiratory compromise requiring reintervention due to airway compression.     

Fully covered removable nitinol self-expandable metal stents (SEMS) in malignant strictures of the esophagus: a multicenter analysis

Background

Fully covered esophageal self-expandable metallic stents (SEMS) often are used for palliation of malignant dysphagia. However, experience and data on these stents are still limited. The purpose of this multicenter study was to evaluate the efficacy and safety of fully covered nitinol SEMS in patients with malignant dysphagia.

Methods

37 patients underwent placement of a SEMS during a 3?year period. Five patients underwent SEMS placement as a bridge to surgery: one for tracheoesophageal fistula in the setting of squamous cell carcinoma of the esophagus, one for perforation in setting of esophageal adenocarcinoma, 27 for unresectable esophageal cancer (16 adenocarcinoma, 11 squamous cell carcinoma), two for lung cancer, and one for breast-cancer-related esophageal strictures.

Results

SEMS placement was successful in all 37 patients. Immediate complications after stent deployment included chest pain (n?=?6), severe heartburn (n?=?1), and upper gastrointestinal bleeding requiring SEMS revision (n?=?1). Dysphagia scores improved significantly from 3.2?±?0.4 before stent placement to 1.4?±?1.0 at 1?month (P?P?P?=?0.0018) at 6?months. The stent was removed in 11 patients (30%) for the following indications: resolution of stricture (n?=?3), stent malfunction (n?=?5), and stent migration (n?=?3). After stent removal, three patients were restented, three underwent dilation, and two underwent PEG placement. Mean survival for the 37 patients after stent placement was 146.3?±?143.6 (range, 13–680) days.

Conclusions

Our study suggests that fully covered SEMS placement improve dysphagia scores in patients with malignant strictures, particularly in the unresectable population. Further technical improvements in design to minimize long-term malfunction and migration are required.     

SELF-EXPANDABLE METAL STENTS FOR MALIGNANT DYSPHAGIA

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.     

Palliation of malignant dysphagia: an alternative to surgery.

This paper presents the results of palliative treatment of 474 patients with malignant dysphagia. Laser produces good relief of symptoms but requires frequent repetition. Self-expanding metal stents provide one-off relief of dysphagia but do have complications. A randomised trial of laser versus covered and uncovered metal stents has demonstrated improved relief of dysphagia of stents over laser, but highlighted the problems at the cardia when stents are used. Chemotherapy in patients with advanced adenocarcinoma using epirubicin, cisplatin and 5-fluorouracil produces a response in two-thirds of cases, with relief of dysphagia and possible increase in survival. A treatment plan for palliation of patients with malignant dysphagia is presented.     

Esophageal Stenting and Radiotherapy: A Multimodal Approach for the Palliation of Symptomatic Malignant Dysphagia

Background

Esophageal stents provide immediate palliation of malignant dysphagia; however, radiotherapy (RT) is a superior long-term option. We review the outcomes of combined esophageal stenting and RT for patients with malignant dysphagia.

Methods

We retrospectively reviewed patients with esophageal stents placed for palliation of malignant dysphagia from esophageal stricture, esophageal extrinsic compression, or malignant tracheoesophageal fistula (TEF). We excluded patients with radiation-induced TEF in the absence of tumor. We analyzed and compared outcomes between patients with no RT, RT before stent placement, and RT after stent placement.

Results

We placed stents in 45 patients for esophageal stricture from esophageal cancer (n?=?30; 66.7?%), malignant TEF (n?=?8; 17.7?%), and esophageal compression from airway, mediastinal, or metastatic malignancies (n?=?7; 15.6?%). Twenty patients (44.4?%) had no RT; 25 patients had RT before stent placement (n?=?16; 35.6?%), RT after stent placement (n?=?8; 17.8?%), or both (n?=?1; 2.2?%). Median follow-up was 30?days. Complications requiring stent revision were similar with or without RT. Subjective symptom relief was achieved in 68.9?% of all patients, with no differences noted between groups (p?=?0.99). The 30-day mortality was 15.6?%. Patients with RT after stent placement had a longer median survival compared to those without RT (98 vs. 38?days).

Conclusions

Esophageal stent placement with RT is a safe approach for malignant dysphagia.     

Double stenting for esophageal and tracheobronchial stenoses

Background. We examined the complications and outcomes of placing stents for both esophageal and tracheobronchial stenoses.

Methods. We placed stents for both esophageal and tracheobronchial stenoses in 8 patients (7 with esophageal cancer and 1 with lung cancer). Covered or noncovered metallic stents were used for the esophageal stenoses, except in 1 patient treated with a silicone stent. Silicone stents were used for the tracheobronchial stenoses. The grades of esophageal and tracheobronchial stenoses were scored.

Results. All patients experienced improvement of grades of both dysphagia and respiratory symptoms after stent therapy. The complications were: (1) 2 patients suffered respiratory distress after placement of the esophageal stent because of compression of the trachea by the stent; and (2) 3 patients developed new esophagotracheobronchial fistulae, and 2 patients had recurring fistula symptoms because of growth of preexisting fistulae after the stent placement, which were caused by pressure from the 2 stents. Despite the fistulae, the 5 patients treated with covered metallic stents did not complain of fistula symptoms, but 2 patients treated with noncovered metallic or silicone stents did complain.

Conclusions. For patients with both esophageal and tracheobronchial stenoses, a stent should be introduced into the tracheobronchus first. Because placement of stents in both the esophagus and tracheobronchus has a high risk of enlargement of the fistula, a covered metallic stent is preferable for esophageal cancer involving the tracheobronchus.     

Palliation of dysphagia from inoperable oesophageal carcinoma using Atkinson tubes or self-expanding metal stents

Until recently, intubation for the palliation of malignant dysphagia has relied upon the insertion of a variety of plastic tubes. Self-expanding metal stents are reported to have a lower complication rate. We have compared the results of Atkinson tube insertion with self-expanding metal stents in patients with inoperable oesophageal carcinoma. From 1990 to 1994 Atkinson tubes were inserted for the palliation of dysphagia from oesophageal cancer, from 1994 onwards self-expanding metal stents were used. Complications, mortality and hospital stay were compared in both groups of patients. In all, 87 patients with inoperable oesophageal carcinoma were treated, 46 with an Atkinson tube and 41 with metal stents. Complications occurred at similar rates in both groups (56% Atkinson tubes, 44% metal stents). There was a significantly higher perforation rate associated with Atkinson tube insertion (8 patients, 17%) compared with metal stents (1 patient, 2.4%, P = 0.02, chi 2). The length of stay was also significantly higher in the Atkinson tube group (median 10 days) compared with the metal stent group (3 days, P < 0.01, Mann-Whitney U test). Mortality rates were similar in both groups. The use of metal stents for the palliation of dysphagia in inoperable oesophageal carcinoma results in a lower perforation rate and a reduced length of stay and they represent a significant advantage over Atkinson tubes.     

Self-expanding metallic stents in the management of advanced esophageal cancer: a review

Palliation of advanced esophageal cancer continues to be a challenge to clinicians. Self expanding metal stents have been used in the esophagus for palliation of advanced esophageal cancer since 1983. They are relatively easy to insert by practicing endoscopists and have low rates of early complications. Delayed complications necessitating reintervention can arise in as many as a third of patients. The majority of stents are placed under sedation using endoscopy and fluoroscopy. Once deployed, they expand in the esophagus causing pressure necrosis on the wall of the esophagus. Several stents are available on the market with newer designs continuing to emerge. Choice of stent seems random among clinicians. Stents have been used for the management of esophageal obstruction including cervical esophageal obstruction and obstruction at the esophagogastric junction, tracheopulmonary fistulae, and mediastinal esophageal compression. Complications include chest pain, deployment and expansion problems, stent migration, tumor overgrowth and ingrowth, gastroesophageal reflux, and stent-related hemorrhage. Despite their high cost, stenting produce better palliation and some cost savings in comparison to conventional methods of palliation. Combination therapy using stenting followed by chemo/radio therapy may increase quality survival.     

Use of the Polyflex stent in the palliative therapy ofesophageal carcinoma

BACKGROUND: Several prospective randomized trials have shown that self-expanding stents have advantages over conventional plastic tubes. Nevertheless, the optimal stent has not yet been developed. The Polyflex stent is a completely new model that represents an improvement over the old metal stents. We have used this stent in a prospective study and herein our present preliminary results. METHODS: In 14 patients with nonresectable esophageal carcinoma, the Polyflex stent was implanted to reduce dysphagia. The grade of dysphagia, the complications following intervention, and the patients' total survival time were documented prospectively every 4 weeks. RESULTS: The implantation of the stent was successful in all cases. The grade of the dysphagia was reduced from 3.0 to 0.5 after stent implantation. One patient died during the hospital stay from a non-stent-induced complication. Stent dislocation occurred once, and tumor overgrowth at the stent margins was observed twice. The mean survival time was 6.2 months, and the reintervention rate was 21.3%. CONCLUSION: The new Polyflex stent, which is based on a completely new design, can be implanted without any difficulty and has had very good short- and long-term results. Therefore, it is a worthy alternative to the metal stents in current use.     

Airway Simulation to Guide Stent Placement for Tracheobronchial Obstruction in Lung Cancer

Background. To effectively palliate large airway obstruction in advanced unresectable lung cancer (stage IIIB or IV), we developed an airway imaging technique to guide selective endobronchial metallic stent placement.

Methods. Fourteen consecutive patients with severe dyspnea (American Thoracic Society grade 4) had a combination of fiberoptic bronchoscopy, chest roentgenography, computed tomographic scanning, helical computed tomography with three-dimensional reconstruction, and intraluminal bronchography with selective bronchial guidewire placement under fluoroscopy to visually reconstruct and simulate the abnormal airway before and during stent placement. Wallstent or Gianturco intraluminal stents were used alone or in combination (up to five stents) to establish patency of the distal trachea and the major bronchi.

Results. All 14 patients had successful deployment with initial relief of airway stenosis (>75% predicted diameter). No procedural complications were noted. However, technical problems included stent foreshortening and imprecision of placement, misinterpretation of bronchography (mucous versus tumor), and airway maintenance during manipulation. Length of stay attributable to the procedure averaged 4 days. Stent placement initially improved the dyspnea score in 7 of 14 patients. Five of 14 died in less than 1 month, with the remainder alive at up to 8 months’ follow-up. Of those surviving more than 1 month, the Karnofsky score improved in 4 and was unchanged in 5, with 2 dependent (Karnofsky score <50), 3 functional (Karnofsky score, 50 to 70), and 4 active (Karnofsky score >70).

Conclusions. A protocol combining helical computed tomography with three-dimensional reconstruction, bronchography, and bronchoscopy allows accurate assessment of malignant airway obstruction to facilitate intralumenal stent placement for relief of stenosis. Patient selection to favor effective palliation and cost effectiveness has yet to be defined.     

Expandable metallic stents in the management of malignant oesophageal obstruction

BACKGROUND: Malignant oesophageal obstruction with an advanced disease presents a difficult challenge. A new class of metal stents have been developed to overcome the limitations of existing treatment modalities. METHODS: We present our first 58 patients, who have been treated with self-expandable metallic stents, using sedation anaesthesia, with fluoroscopic and endoscopic control. Both kinds of stents, covered and uncovered, were applied. RESULTS: There was no procedure-related mortality. The immediate relief of dysphagia was 98%. All four oesophageal fistulas were successfully sealed with covered stents. Due to stent migration, tumour overgrowth, or ingrowth, twelve (21%) of the patients needed re-intervention. Restenting or laser therapies were used against recurrent dysphagia. CONCLUSION: The palliation of oesophageal malignant obstruction with metal stents is a rapid, effective, and relatively safe single treatment which can be employed as part of a multimodal treatment program.     

全覆膜食管金属支架治疗高位食管疾病

目的评价全覆膜食管金属支架在高位食管狭窄和瘘以及术后吻合口狭窄和瘘治疗中的有效性和安全性。方法复旦大学附属中山医院内镜中心2005年5月至2013年7月间,应用16mm全覆膜食管金属支架对84例高位食管狭窄和瘘以及术后吻合口狭窄和瘘进行治疗。其中食管癌性狭窄31例,食管外压性狭窄2例,食管癌放疗后狭窄10例,食管癌术后复发致狭窄4例,吻合口狭窄27例,内镜黏膜下剥离术后食管狭窄1例,食管．气管瘘7例,食管一纵隔瘘1例,食管癌术后残胃瘘1例。狭窄或瘘口上缘距中切牙距离15～20cm者48例,大于20cm者36例。结果84例患者共置入100枚支架,术中无出血和穿孔等并发症发生。支架置入术后患者吞咽困难、呛咳症状均迅速缓解。术后并发症发生率为6．0％（5／84）,其中严重胸痛2例,经止痛药物缓解;气管塌陷1例,予气管切开术;支架移位2例,内镜下应用异物钳对支架位置进行调整。76例（90．5％）患者获得完整随访,5-3％（4／76）的患者出现再狭窄,2．6％（2／76）新发食管．气管瘘;其中5例接受再次内镜下置入全覆膜金属支架术并获成功,另1例经沙氏探条扩张及氩离子凝固术治疗效果满意。结论全覆膜食管金属支架治疗高位食管狭窄和瘘以及术后吻合口狭窄和瘘安全、有效,可考虑作为临床首选。     

Removal of esophageal expandable metal stents

BACKGROUND: Expandable metallic stents (EMS) have seen wide application in patients with malignant stricture and fistulas. They have not seen wide application for benign disease because of concern over acute complications and long-term sequelae. METHODS: Between June 1999 and October 2000, six patients with EMS in place for malignant stricture (n = 3), benign stricture (n = 1), anastomotic leak (n = 1) and benign esophagorespiratory fistula (n = 1) had their stents endoscopically removed. Removal was performed secondarily to the following complications: secondary stricture (n = 1), epidural abscess (n = 1), diskitis (n = 1), resolution of fistula (n = 2), and resolution of anastomotic leak (n = 1). RESULTS: Four patients had one EMS: Ultraflex (n = 3) and Z-stent (n = 1). In two patients, two stents (Ultraflex and Z-stent) were retrieved simultaneously. No procedurally related complications occurred. Two patients with esophageal cancer required additional stents. All three patients with benign fistula and stricture recovered uneventfully. CONCLUSIONS: The safe removal of current brands of EMS may facilitate the wider application of these devices to include selective patients with benign disease.