Palliation of malignant esophageal strictures with self-expanding nitinol stents: drawbacks and complications

• Published in: Radiology Vol. 199; no. 3; p. 648
• Main Authors: Acunaş, B, Rozanes, I, Akpinar, S, Tunaci, A, Tunaci, M, Acunaş, G
• Format: Journal Article
• Language: English
• Published: United States 01-06-1996
• Subjects: Adenocarcinoma - complications; Adenocarcinoma - diagnostic imaging; Adenocarcinoma - therapy; Adult; Aged; Alloys; Carcinoma, Squamous Cell - complications; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - therapy; Deglutition Disorders - diagnostic imaging; Deglutition Disorders - etiology; Deglutition Disorders - therapy; Esophageal Neoplasms - complications; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - therapy; Esophageal Stenosis - diagnostic imaging; Esophageal Stenosis - etiology; Esophageal Stenosis - therapy; Esophagus - diagnostic imaging; Female; Humans; Lung Neoplasms - complications; Male; Middle Aged; Neoplasm Recurrence, Local - complications; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - therapy; Palliative Care - methods; Radiography; Stents - adverse effects
• ISSN: 0033-8419
• DOI: 10.1148/radiology.199.3.8637981

To evaluate the usefulness of self-expanding nitinol stents in the palliative treatment of malignant dysphagia.
Eighty self-expanding nitinol stents were placed in 59 patients (43 men, 16 women; mean age, 55 years; age range, 23-75 years) with inoperable malignant stenosis due to squamous cell carcinoma of the esophagus (n = 36), adenocarcinoma (n = 19), invasion of the esophagus due to carcinoma of the lung (n = 2), and recurrent anastomotic carcinoma (n = 2). Dysphagia was graded on a scale of 0 to 3. Follow-up esophagograms were obtained to evaluate stent patency.
Stent placement was successful in all patients. The severity of dysphagia decreased at least one grade in all but one patient. Tumor ingrowth and overgrowth were seen in 21 (36%) patients 2 days to 7 months after stent placement and caused recurrent dysphagia. These 21 patients underwent balloon dilation and additional stent placement. A mediastinal fistula was seen in three patients (5%), ulceration in four (7%), stent torsion in three (5%), and incomplete expansion of the stent in two (2%). Repeat intervention was necessary in 51% of the patients.
There is a substantial range of drawbacks and complications associated with the use of self-expanding nitinol stents for palliation of malignant esophageal strictures. A covering would be necessary to prevent tumor ingrowth.