Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Gastrointest Endosc. 2012 Jul;76(1):44-51. doi: 10.1016/j.gie.2012.02.036.
Most patients with locally advanced esophageal cancer requiring neoadjuvant therapy have significant dysphagia.
To report our experience in using a fully covered self-expandable metal stent (FCSEMS) to treat malignant dysphagia and for maintenance of nutritional support during neoadjuvant therapy.
Retrospective study.
Two tertiary-care referral centers.
This study involved 55 patients with locally advanced esophageal cancer (50 adenocarcinoma, 5 squamous cell carcinoma). Forty-three patients were men, and the mean age was 65.8 years.
EUS followed by FCSEMS placement.
Procedural success, dysphagia scores, patient weights, stent migration, and stent-related complications.
All stents were successfully placed. Tumors were located in the middle esophagus (n = 10) and distal esophagus (n = 45). The mean dysphagia score obtained at 1 week after stent placement had improved significantly from baseline (2.4 and 1, respectively; P < .001). Patients maintained their weights at 1 month follow-up when compared with baseline (153 and 149 pounds, respectively; P = .58). Immediate complications included chest discomfort in 13 patients; 2 patients required stent removal because of intractable pain. One patient had stent removal because of significant acid reflux. Stent migration occurred at some point in 17 of 55 patients (31%). There was a delayed perforation in 1 patient. Because of disease progression or the discovery of metastasis after neoadjuvant therapy, only 8 of 55 patients underwent curative surgery.
Retrospective study.
Placement of FCSEMSs in patients with locally advanced esophageal cancer significantly improves dysphagia and allows for oral nutrition during neoadjuvant therapy. FCSEMSs appear to be effective for palliating dysphagia. Migration was not associated with injury or harm to the patient and usually represented a positive response to neoadjuvant therapy. Few patients undergoing stenting in this situation ultimately undergo surgery because of disease progression or poor operative candidacy.
大多数需要新辅助治疗的局部晚期食管癌患者都有明显的吞咽困难。
报告我们使用全覆膜自膨式金属支架（FCSEMS）治疗恶性吞咽困难和新辅助治疗期间维持营养支持的经验。
回顾性研究。
两个三级转诊中心。
这项研究涉及 55 例局部晚期食管癌患者（50 例腺癌，5 例鳞状细胞癌）。43 例为男性，平均年龄 65.8 岁。
EUS 后放置 FCSEMS。
程序成功率、吞咽困难评分、患者体重、支架移位和支架相关并发症。
所有支架均成功放置。肿瘤位于食管中段（n=10）和食管下段（n=45）。支架放置后 1 周的平均吞咽困难评分与基线相比显著改善（分别为 2.4 和 1；P<.001）。与基线相比，患者在 1 个月随访时保持体重（分别为 153 和 149 磅；P=0.58）。即刻并发症包括 13 例胸痛；2 例因难治性疼痛而需要取出支架。1 例因明显胃酸反流而取出支架。55 例患者中有 17 例（31%）出现支架移位。1 例出现延迟性穿孔。由于新辅助治疗后疾病进展或发现转移，仅有 8 例 55 例患者接受了根治性手术。
回顾性研究。
在局部晚期食管癌患者中放置 FCSEMS 可显著改善吞咽困难，并允许在新辅助治疗期间口服营养。FCSEMS 似乎对缓解吞咽困难有效。支架移位与患者损伤或伤害无关，通常代表对新辅助治疗的积极反应。在这种情况下进行支架置入的少数患者最终因疾病进展或手术条件差而无法接受手术。
