Endoscopy 2003; 35(8): S14-S18
DOI: 10.1055/s-2003-41537
Esophagus
© Georg Thieme Verlag Stuttgart · New York

Esophageal Stenting in Unusual Situations

C.  S.  Shim1
  • 1Institute for Digestive Research, Digestive Disease Center, Soon Chun Hyang University College of Medicine, Seoul, Korea
Further Information

Publication History

Publication Date:
20 August 2003 (online)

Introduction

Esophageal cancer is frequently unresectable at the time of diagnosis because of local invasion or metastatic disease. Therapy is therefore usually palliative in nature, with the major aims being relief of dysphagia, maintenance of nutrition and occlusion of tracheoesophageal fistula. Palliative surgery eventually offers the best palliation for esophageal obstruction symptoms and signs such as dysphagia and vomiting. However because of the very poor prognosis, the short median survival time and the considerable morbidity and mortality rate of surgery, this approach cannot be justified in preference to less invasive nonsurgical techniques.

There are numerous nonsurgical palliative treatments, including radiation therapy (external or intracavitary), endoscopic stenting, chemotherapy, endoscopic tumor ablation with BICAP electrocoagulation and argon plasma coagulation (APC), injection of necrolytic agents, Nd:YAG laser photocoagulation and photodynamic therapy. Recently various self-expandable metal stents (SEMS) have been developed for palliation of malignant obstruction of the esophagus.

The major impact of these stents is associated with the ease of insertion and the potential for fewer complications compared with plastic stents. Because SEMS offer many advantages, endoscopists have in recent times preferred to use SEMS for the treatment of esophageal obstruction. In spite of the many advantages of SEMS, limitations and difficulty are sometimes encountered in esophageal stenting because of complete luminal obstruction; sharp angulation of the esophagus due to tortuous tumor growth; previous surgery; previous radiotheraphy and severe kyphoscoliosis; the tumor’s being unusually soft and necrotic or excessively hard and scirrhous; the presence of fistula in the absence of appreciable luminal constriction starting at the upper or lower end of the malignancy; and extension of the tumor to the upper esophageal sphincter.

References

  • 1 Lorken A, Krampert J, Kau R J, Arnold W. Experience with the Monogomery salivary bypass tube.  Dysphagia. 1997;  12 79-83
  • 2 Spinelli P, Parasher V K, Meroni E. et al . Treatment of nondilatable malignant pharyngoesophageal strictures by Mongomery salivary bypass tube: a new approach.  Gastrointest Endosc. 1995;  41 601-603
  • 3 Loizou L A, Rampton D, Brown S G. Treatment of malignant strictures of the cervical esophagus by endoscopic intubation using modified endoprosthesis.  Gastrointest Endosc. 1992;  38 158-164
  • 4 Goldschmid S, Boyce H W, Nord H J, Brady P G. Treatment of pharyngoesophageal stenosis by polyvinyl prosthesis.  Am J Gastroenterol. 1988;  83 513-518
  • 5 Macdonald S, Edwards R D, Moss J G. Patient tolerance of cervical esophageal metal stent.  J Vasc Intervent Radiol. 2000;  11 891-898
  • 6 Hordijk M L, Dees J, Biankenstein M. The management of malignant esophago-respiratory fistula with a cuffed prosthesis.  Endoscopy. 1990;  22 241-244
  • 7 Shim C S, Moon J H, Lee J S. et al . Endoscopic treatment with a cuffed prosthesis for malignant esophagobronchial fistula.  Korean Soc Gastrointest Endosc. 1992;  12 221-226
  • 8 Kozarek R A, Raltz S, Brugge W R. et al . Prospective multicenter trial of esophageal Z-stent placement for malignant dysphagia and tracheoesophageal fistula.  Gastrointest Endosc. 1996;  44 562-567
  • 9 Wu W C, Katon R M, Saxon R R, Barton R E, Uchida B T, Keller F S. et al . Silicone-covered self-expanding metallic stents for the palliation of malignant esophageal obstruction and esophagorespiratory fistulas: experience in 32 patients and a review of the literature.  Gastrointest Endosc. 1994;  40 22-33
  • 10 Symonds C J. A case of malignant stricture of the esophagus illustrating the use of a new form of esophageal catheter.  Trans Chir Soc Lond. 1885;  18 155-158
  • 11 Shim C S, Cho Y D, Moon J H. et al . Fixation of a modified covered esophageal stent: its clinical usefulness for preventing stent migration.  Endoscopy. 2001;  33 843-848
  • 12 Dua K S, Kozarek R A, Kim J. et al . Self-expanding metal esophageal stent with anti-reflux mechanism.  Gastrointest Endosc. 2001;  52 603-613
  • 13 Song H Y, Park S I, Do Y S. et al . Expandable metallic stent placement in patients with benign esophageal strictures: results of long term follow up.  Radiology. 1997;  203 131-136

C. S. Shim, M. D., Ph. D. 

Professor of Medicine · Chief of Digestive Disease Center · College of Medicine · Soon Chun Hyang University

657 Hannam-Dong, Yongsan-Ku · Seoul 140-743 · Korea

Phone: + 82-2-709-9202

Fax: + 82-2-749-1968

Email: schidr@hosp.sch.ac.kr