Endoscopic placement of indigenous plastic esophageal endoprostheses--does it still have a role in the era of expandable metallic stents? A prospective Indian study in 265 consecutive patients.

BACKGROUND AND STUDY AIMS

Esophageal endoprosthesis placement is an established method of palliating inoperable esophageal malignancy. However, the prosthesis choice varies, with expandable metal stents recently gaining popularity. We present our experience of using an indigenously developed plastic prosthesis in 265 patients prospectively in the period April 1992 to May 1996.

PATIENTS AND METHODS

An indigenous endoprosthesis made of a medical grade, nontoxic, radiopaque plastic material was placed successfully in 259 patients after serial dilatation of the malignant stricture. Patients were followed up once every month for at least 6 months and also in between if they developed any significant symptoms. The results were analyzed prospectively with special emphasis on the cost of the therapy, technical success of placement, improvement of swallowing and occurrence of complications.

RESULTS

The technical success of placement was 97.7% (259/265 patients). The mean dysphagia score improved from 3.2 to 1.2; 212 patients (81.8%) could swallow semisolids whereas 47 patients (18.2%) could swallow liquids. Though 75 patients (28.3%) had an associated tracheoesophageal fistula and 29.8% had received prior radiotherapy/chemotherapy, immediate complications like perforation, respiratory distress or severe hemorrhage were encountered in only 4.3% of patients. Late complications occurred in 12.7% and 32.8% of the patients complained of mild post-procedure pain in the chest. The overall procedure-related mortality was 3.9%. The average cost of the prosthesis was only US$ 15 per patient.

CONCLUSIONS

Placement of a plastic prosthesis is still a very effective and safe method for relief of malignancy-induced dysphagia. The associated complications can be significantly reduced by modifying the prosthesis material/design and adhering to a careful technique. The extremely low cost of the prosthesis and its safety profile makes this treatment highly cost-effective and widely applicable in developing countries such as India.