Raijman I, Siddique I, Ajani J, Lynch P
Division of Gastroenterology, M. D. Anderson Cancer Center, Houston, Texas, USA.
Gastrointest Endosc. 1998 Aug;48(2):172-9. doi: 10.1016/s0016-5107(98)70159-2.
Insertion of coated expandable esophageal stents is the preferred endoscopic palliative treatment for malignant dysphagia and digestive-respiratory fistulae.
One hundred one patients with malignant dysphagia and digestive-respiratory fistulae, 83 due to esophageal cancer and 18 due to metastatic disease, underwent placement of a coated expandable metal stent. Thirteen patients had a digestive-respiratory fistula. The stricture location (99 patients) was proximal in 11, mid in 29, distal in 37, and at the gastroesophageal junction in 24. The endoscopic appearance was exophytic in 80, infiltrative in 19, single ulcer in 1, and normal in 1. The mean stricture length was 6.7 cm.
Initial stent placement was successful in 100 patients; a second stent was required in 1. The median dysphagia grade improved from 3.6 to 1.4 and sealing-off of the digestive-respiratory fistula was successful in all cases. The overall complication rate was 37.9%. Life-threatening complications occurred in 7.9%. There were no procedure-related deaths. During a mean follow-up of 201 days, 99 patients died-none from stent-related problems.
This large series confirms the efficacy of the coated metal expandable stent in the palliation of malignant dysphagia and digestive-respiratory fistula with an acceptable complication rate.
置入覆膜可扩张食管支架是治疗恶性吞咽困难和消化-呼吸道瘘的首选内镜姑息治疗方法。
101例患有恶性吞咽困难和消化-呼吸道瘘的患者，其中83例因食管癌，18例因转移性疾病，接受了覆膜可扩张金属支架置入术。13例患者有消化-呼吸道瘘。狭窄部位（99例患者）：近端11例，中段29例，远端37例，胃食管交界处24例。内镜表现：外生性80例，浸润性19例，单发溃疡1例，正常1例。平均狭窄长度为6.7 cm。
100例患者首次支架置入成功；1例需要置入第二个支架。吞咽困难的中位数分级从3.6改善至1.4，所有病例的消化-呼吸道瘘封堵均成功。总体并发症发生率为37.9%。危及生命的并发症发生率为7.9%。无手术相关死亡。在平均201天的随访期间，99例患者死亡，均非支架相关问题所致。
这个大型系列研究证实了覆膜金属可扩张支架在缓解恶性吞咽困难和消化-呼吸道瘘方面的疗效，并发症发生率可接受。
