[Self-expanding metal prosthesis as palliative treatment in esophageal cancer].

BACKGROUND

Current non-surgical or endoscopic therapeutic modalities in esophageal cancer include dilatation, thermocoagulation, injection of alcohol or chemotherapeutic agents, photodynamic therapy, intracavitary irradiation, and placement of plastic or metallic prostheses. None of these procedures, however, has proved to be a simple and well-tolerated like the last one.

AIM

Achieve palliation of dysphagia, in patients with nonresectable esophageal cancer treated with a metal self-expanding endoprosthesis. PATIENTS--METHODS AND RESULTS: Twelve patients (6 men and 6 women, mean age 58) with dysphagia caused by non-resectable esophageal cancer were treated with a metal self-expanding endoprosthesis. Prior to treatment, they had mean dysphagia grade of 3.5. Histologic diagnosis was squamous carcinoma in 4 cases, and adenocarcinoma in 8. Six tumors were located at the gastroesophageal junction, 4 in the distal esophagus, and 2 in the mid-esophagus. None of the patients had cervical esophageal tumor. All procedures were performed under mild intravenous sedation. Stent insertion was technically successful in 91.6%, and led to a reduction of dysphagia from a mean score of 3.5 to a mean score of 0.5 at first and 4th weeks. Ninety-one percent of the patients continued to swallow during follow-up (average follow-up: 10.5 weeks, range 1 day-35 weeks). Early complications (within 30 days) included retrosternal pain in 2 patients which resolved in a few days and one patient with recurrent bleeding from the tumor site.

CONCLUSIONS

Self-expanding metal stents placement is a relatively simple and atraumatic procedure, it is safe and effective in treatment of malignant dysphagia.