Self-Expandable Metal Stents in Palliation of Inoperable Esophageal & Gastro-Oesophageal Carcinoma

Abstract

Background More than half of patients with carcinoma of the esophagus are inoperable at the time of presentation. A number of treatment options are available to relieve dysphagia. The aim of this study was to evaluate the results of self expandable metal stents for the treatment of malignant dysphagia. Material & methods This a prospective study was conducted at Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Egypt from July 2009 to Dec 2010. Ten Enrolled patients with grade 3 or 4 dysphagia due to inoperable carcinoma of the esophagus and gastrooesophageal junction underwent Self Expandable Metal Stenting under endoscopic guidance. They were followed during all the study period. Dysphagia score will be calculated at baseline and at follow up according to Atkinson's scale. Patients were assessed for complications. Data were analyzed using SPSS version 10. Results Mean age of patients was 55.5 ± 15 years with male to female ratio of 3:2. Mean dysphagia score improved from 3.4 (pre-stent) to 1.07 (post-stent) (p < 0.05). Improvement in dysphagia (conversion of grade 3 or 4 dysphagia into grade 1 or 0) was seen in 90% patients. Four patients required re-intervention after initial improvement for their stent blockage (40%) and one patient followed conservatively for stent migration (10%). Other minor complications like cough and regurgitation occurred in 10% and 40% patients respectively. Most patients experienced severe chest pain necessitating narcotic analgesics. One patient with pulmonary mets died within one week, three patients died within 3 months, three patients died within 1.5 years and three patients under flow-up are still alive at the time this was written. Conclusion In patients with inoperable carcinoma esophagus self expandable metal stents are an effective method for palliation of dysphagia but not without complications.