Expandable Stents for Malignant Esophageal Disease
Section snippets
Esophageal cancer
Rapid and persistent palliation of dysphagia is one of the main challenges in treating patients with incurable esophageal cancer to improve their quality of life. Brachytherapy and placement of an expandable stent are the 2 most evidence-based palliative treatment options for these patients. Two randomized controlled studies comparing expandable stent placement with brachytherapy have shown that self-expandable metal stent (SEMS) insertion provides rapid palliation of dysphagia when compared
Esophagorespiratory fistulas
Malignant esophagorespiratory fistulas (EFs) (Fig. 4) are a complication of primary tumor growth or recurrence of esophageal or lung cancer, or may result from chemotherapy and/or radiation therapy, leading to tumor necrosis. EFs result in frequent aspiration (pneumonia) and poor nutritional intake. The mean survival of patients with this complication is from 1 to 6 weeks with supportive care alone.32
Surgical closure, resection, or bypass surgery does not produce good palliative results for
Bridge-to-surgery stenting
An increasing proportion of patients with resectable esophageal cancer are being treated with neoadjuvant chemotherapy and radiotherapy or definite chemoradiation. Some of these patients into, however, have severe dysphagia and weight loss while receiving such treatment. Temporary expandable stent placement, sometimes referred to as bridge-to-surgery stenting, is an option rather than nasoenteric feeding tube or percutaneous endoscopic gastrostomy tube placement and instantly restores
Recurrent local tumor growth after esophagectomy
A substantial proportion of patients present with recurrent dysphagia because of locoregional recurrence or mediastinal metastasis within 2 years after esophagectomy and gastric conduit reconstruction (Fig. 6). Because the prognosis is dismal in these patients and rapid relief of dysphagia is therefore required, expandable stent placement seems the most optimal palliative treatment option. A recent prospective cohort study on 81 patients with recurrent tumor growth after esophagectomy
Extrinsic malignant compression on the esophagus
Malignant dysphagia because of extrinsic compression on the esophagus is another indication for palliative expandable stent placement because the majority of these patients are incurable, with a predicted life expectancy of less than 6 months. Partially as well as fully covered SEMSs have been used in this patient population with good relief of dysphagia. Despite the absence of intraluminal tumor growth, stent migration was observed in only 4% of cases in a recently published series of 50
Very proximal esophageal cancers
Tumors close to (<2 cm) the upper esophageal sphincter (UES) are seen in 7% to 10% of all esophageal cancers and are traditionally considered to be a contraindication to expandable stent placement because of the increased risk of complications such as perforation, airway compression, proximal migration, aspiration pneumonia, and discomfort due to pain and globus sensation. However, this belief has changed because several studies have shown that stent placement in patients with tumors located
Summary
The currently available expandable stents for malignant esophageal disease provide rapid and sufficient palliation of dysphagia. The rate of recurrent dysphagia due to stent migration varies, with SEPSs and fully covered SEMSs having higher migration rates than partially covered SEMSs. In contrast, tissue ingrowth or overgrowth is more frequently observed with partially covered stents. Antireflux stents can be used in patients with refractory reflux esophagitis despite PPI treatment; however,
References (45)
Esophageal cancer
Gastroenterol Clin North Am
(2008)- et al.
Endoscopic Nd: YAG laser therapy as palliation for esophagogastric cancer. Parameters affecting initial outcome
Gastroenterology
(1985) - et al.
Palliative ethanol injection of unresectable advanced esophageal carcinoma combined with chemoradiation
Am J Med Sci
(2006) - et al.
Intratumoral cisplatin/epinephrine-injectable gel as a palliative treatment for accessible solid tumors: a multicenter pilot study
Otolaryngol Head Neck Surg
(1998) - et al.
Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial
Lancet
(2004) - et al.
Placement of Polyflex stents in patients with locally advanced esophageal cancer is safe and improves dysphagia during neoadjuvant therapy
Gastrointest Endosc
(2009) - et al.
Effect of stent size on complications and recurrent dysphagia in patients with esophageal or gastric cardia cancer
Gastrointest Endosc
(2007) - et al.
A new metal stent with a controlled-release system for palliation of malignant dysphagia: a prospective, multicenter study
Gastrointest Endosc
(2010) - et al.
A new partially covered metal stent for palliation of malignant dysphagia: a prospective follow-up study
Gastrointest Endosc
(2010) - et al.
A fully-covered stent (Alimaxx-E) for the palliation of malignant dysphagia: a prospective follow-up study
Gastrointest Endosc
(2009)
A new fully covered stent with antimigration properties for the palliation of malignant dysphagia: a prospective cohort study
Gastrointest Endosc
A new esophageal stent design (Niti-S) for the prevention of migration: a prospective follow-up study in 42 patients
Gastrointest Endosc
Stent placement in esophageal cancer as a bridge to surgery
Gastrointest Endosc
Esophageal stents with antireflux valve for tumors of the distal esophagus and gastric cardia: a randomized trial
Gastrointest Endosc
Tracheoesophageal fistula
Chest Surg Clin N Am
Evolving role of self-expanding metal stents in the treatment of malignant dysphagia and fistulas
Gastrointest Endosc
Palliative treatment of malignant esophagorespiratory fistulas with Gianturco-Z stents. A prospective clinical trial and review of the literature on covered metal stents
Am J Gastroenterol
Palliation of malignant dysphagia and fistulae with coated expandable metal stents: experience with 101 patients
Gastrointest Endosc
Esophageal stents for the palliation of malignant dysphagia and fistula recurrence after esophagectomy
Gastrointest Endosc
Esophageal stents for malignant strictures close to the upper esophageal sphincter
Gastrointest Endosc
Single-dose brachytherapy for the palliative treatment of esophageal cancer
Endoscopy
Photodynamic therapy for esophageal carcinoma
Surg Endosc
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In vitro studies of biodegradable Zn-0.1Li alloy for potential esophageal stent application
2020, Materials LettersCitation Excerpt :Stent implantation has been proved effective for treatment. At present, most esophageal stents are traditional metal materials, including nitinol and stainless steel [2]. Despite the favorable strength, the current metallic stents displayed poor compliance and histocompatibility, due to its un-degradable nature.
Adverse events of self-expandable esophageal metallic stents in patients with long-term survival from advanced malignant disease
2017, Gastrointestinal EndoscopyFully covered stents versus partially covered stents for palliative treatment of esophageal cancer: Is there a difference?
2018, Revista de Gastroenterologia de Mexico
The authors have nothing to disclose.