Endoscopic treatment of malignant stenosis in home care

At our institute, we have tried to increase the patient's quality of life (QOL) by endoscopic stenting for upper intestinal stenosis due to malignant tumor, which could not be treated by surgery or chemotherapy. We report the endoscopic stenting and home therapy for those patients. The subjects were 44: (esophageal stenosis: 13 cases, biliary stenosis: 31 cases) out of 60 patients who had intestinal stenosis or obstruction, which could not be treated by surgery or chemotherapy. Esophageal stenosis was treated mainly by stenting and laser cautery, and biliary stenosis was treated by drainage using stenting. The home stay period, effective treat period, life survival period, and complications were analyzed in each case. It was found that the mean home stay period, mean effective treatment period, and mean life survival period were 3.4 months, 4.0 months, and 5.5 months, respectively, with esophageal stenosis, and 3.7 months, 4.4 months, 5.5 months with biliary stenosis. Mean home stay period/life survival period was 62% in cases of esophageal stenosis, and 67% in cases of biliary stenosis. Complications were observed in 40.0% of patients with esophageal stenting and in 12.5% with biliary stenting. Esophageal stenting showed a higher incidence of complications; however improvements in the stenting instrument will reduce the number of complications. Endoscopic stenting is thus effective for upper intestinal stenosis due to malignant tumor, especially in increasing the patient's QOL when curative therapy is not indicated, and the patient stays at home. We believe patients with uncurable malignant disease should have home treatment as early as possible.