Delayed Complications after Placement of Self-Expanding Stents in Malignant Esophageal Obstruction: Treatment Strategies and Survival Rate

Purpose Placement of self-expanding metal stents is regarded as a safe and effective treatment in patients with incurable malignant esophagogastric obstruction. However, proceeding and possible benefit of re-interventions in patients with recurrent dysphagia due to delayed complications (>4 weeks...

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Bibliographic Details
Published in:Digestive diseases and sciences 2008-02, Vol.53 (2), p.334-340
Main Authors: Homann, Nils, Noftz, Maria R., Klingenberg-Noftz, Rolf D., Ludwig, Diether
Format: Article
Language:English
Subjects:
Aged
Biochemistry
Biological and medical sciences
Deglutition Disorders - etiology
Endoscopy
Esophageal Neoplasms - complications
Esophageal Stenosis - etiology
Esophageal Stenosis - therapy
Esophagoscopy
Esophagus
Female
Gastroenterology
Gastroenterology. Liver. Pancreas. Abdomen
Hepatology
Humans
Kaplan-Meier Estimate
Male
Medical sciences
Medicine
Medicine & Public Health
Middle Aged
Oncology
Original Paper
Recurrence
Retrospective Studies
Stents
Time Factors
Transplant Surgery
Tumors
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Summary:Purpose Placement of self-expanding metal stents is regarded as a safe and effective treatment in patients with incurable malignant esophagogastric obstruction. However, proceeding and possible benefit of re-interventions in patients with recurrent dysphagia due to delayed complications (>4 weeks after stent insertion) is unclear. Patients and methods In 133 patients with malignant stricture of the esophagus or the esophagogastric junction 164 expandable metal stents were placed. About 89 patients were followed up until death. All tumor- or stent-related complications and consequent re-interventions were recorded. Results The overall incidence of delayed complications was 53.4% (71 of 133 pts.), with 34 patients (25.6%) experiencing more than one complication. Recurrent dysphagia due to tumor ingrowth (22%) or overgrowth (15%), bolus obstruction (21%), stent migration (9%), and development of esophagorespiratory fistula (9%) was successfully treated by dilatation (24%), placement of a second/third stent (27%), laser therapy (16%), and/or placement of a feeding tube (PEG, 19%). The median survival of patients with endoscopic therapy was significantly longer (222 ± 26 days) compared to patients without re-intervention (86 ± 14 days, P  
ISSN:0163-2116
1573-2568
DOI:10.1007/s10620-007-9862-9