Division of Gastroenterology, Georgetown University Hospital, Washington, District of Columbia, United States.
Division of Gastroenterology, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania, United States.
Endoscopy. 2019 Feb;51(2):169-173. doi: 10.1055/a-0650-4588. Epub 2018 Jul 13.
Proximal esophageal stents are poorly tolerated and have a high risk of complications. We report our experience using fully covered, biliary, self-expandable metal stents (B-SEMS) and narrow-diameter, esophageal, self-expandable metal stents (NDE-SEMS) for this group of patients.
24 patients underwent placement of B-SEMS or NDE-SEMS for proximal esophageal lesions between 1 January 2011 and 31 July 2016. The outcomes included improvement of dysphagia, healing of fistulas, and adverse events.
10 patients received B-SEMS and 14 had NDE-SEMS. Median follow-up time was 11.5 months (range 0.5 - 62 months). In both cohorts, stents were left in place for a mean of 6 weeks. The dysphagia score decreased in 7 (70 %) and 10 (71.4 %) patients, and fistulas resolved in 3/5 (60.0 %) and 5/8 (62.5 %) patients with B-SEMS and NDE-SEMS, respectively. Stent migration occurred in three patients (30.0 %) with B-SEMS and five patients (35.7 %) with NDE-SEMS.
Both stents were well tolerated and resulted in overall improvement of dysphagia in 70.8 % of patients. B-SEMS appeared to be more favorable for cervical esophageal lesions with narrower diameters, while NDE-SEMS may be better for more distal lesions.
近端食管支架的耐受性较差，且并发症风险较高。我们报告了使用全覆膜胆道自膨式金属支架（B-SEMS）和小直径食管自膨式金属支架（NDE-SEMS）治疗这组患者的经验。
2011 年 1 月 1 日至 2016 年 7 月 31 日期间，24 例患者因近端食管病变接受 B-SEMS 或 NDE-SEMS 治疗。结果包括吞咽困难的改善、瘘的愈合和不良事件。
10 例患者接受 B-SEMS，14 例患者接受 NDE-SEMS。中位随访时间为 11.5 个月（0.5-62 个月）。在两个队列中，支架的留置时间平均为 6 周。吞咽困难评分在 7 例（70%）和 10 例（71.4%）患者中降低，B-SEMS 和 NDE-SEMS 组的瘘分别有 3/5（60.0%）和 5/8（62.5%）例得到解决。B-SEMS 组有 3 例（30.0%）和 NDE-SEMS 组有 5 例（35.7%）患者发生支架迁移。
两种支架均具有良好的耐受性，70.8%的患者吞咽困难总体得到改善。B-SEMS 似乎更适合直径较窄的颈段食管病变，而 NDE-SEMS 可能更适合更远端的病变。
