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Research Article

Cancer Research Frontiers. 2016 May; 2(2): 277-285. doi: 10.17980/2016.277

Self-expandable metallic stents for the palliation of malignant dysphagia: a single center experience

 

Iyad Khamaysi1,2,Δ, Maisa Andraous1, Δ, Alain Suissa1,2, Kamal Yassin1,2, Ian M. Gralnek1,3 *

1Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology

2Interventional Endoscopy Unit, Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel

3Institute of Gastroenterology and Hepatology, HaEmek Medical Center, Afula, Israel

Δco-first authors

 

*Corresponding author: Professor Ian M. Gralnek, MD, MSHS, FASGE. Chief, Institute of Gastroenterology and Hepatology, Ha’Emek Medical Center, Afula, Israel. Tel +972-4-649-5545; Email: ian_gr@clalit.org.il

Citation: Iyad Khamaysi et al. Self-expandable metallic stents for the palliation of malignant dysphagia: a single center experience. Cancer Research Frontiers. 2016 May; 2(2): 277-285. doi: 10.17980/2016.277

Copyright: @ 2016 Iyad Khamaysi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Competing Interests: The authors declare no competing financial interests.

Received Oct 25, 2015; Revised Feb 16, 2016; Accepted Mar 10, 2016. Published May 26, 2016

 

Abstract

Introduction: Self-expandable metallic stents (SEMS) for the palliation of unresectable esophageal cancer (EC) is now standard of care. We evaluated the technical success, clinical outcomes, and safety of endoscopic SEMS placement in patients with unresectable EC.

Methods: Retrospective cohort analysis of endoscopy data on all patients with unresectable EC referred for stent placement. Dysphagia scores, pre and post SEMS placement, were calculated in order to define clinical success of SEMS treatment.

Results: A total of 42 patients (28 male, mean age = 73.1 years) underwent endoscopic SEMS placement: 38 (90.5%) with primary esophageal tumor and 4 (9.5%) with an extra-esophageal mass. Tumors were located in the distal n=33 (78.5%), mid n=7 (16.7%), and proximal n=2 (4.8%) esophagus. Technical success of stent placement was 41/42 (97.6%). One technical failure required a second stent placement. Clinical success was achieved in all patients (100%) with significant improvement in dysphagia score. The mean pre-SEMS dysphagia score was 2.88 and the post-SEMS dysphagia score was 1.04 (p<0.00001). A total of 13 (30.9%) patients required re-stenting within a mean of 32 weeks due to tumor ingrowth/overgrowth (n=8), stent migration (n=4), or stent degradation (n=1). No immediate adverse events (AE) occurred. Early AE (within 1 week of stent placement) occurred in 6 (14.3%) patients: vomiting (n=3), stent migration (n=2) and chest pain (n=1). Late AE occurred in n=11 patients: death (n=6) unrelated to stent placement, globus sensation /recurrent dysphagia / food impaction (n=5), and stent migration (n=1). Median survival was 17 weeks.

Conclusions: Endoscopic placement of SEMS for palliation of dysphagia due to unresectable EC is technically feasible, effective, and safe.

Key words: Dysphagia, Esophageal Cancer, Palliation, Stent

 

 

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