A prospective trial of self-expanding metal stents in the palliation of malignant esophageal strictures near the upper esophageal sphincter,☆☆,

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Patients

From October 1992 to March 1996, eight consecutive patients with malignant esophageal strictures near the upper esophageal sphincter (within 3 cm) were prospectively evaluated and treated with expandable metal stents (Table 1).

. Clinical parameters

NumberAge (yr)/SexCancerous tumor typeLocationUpper sphincter from incisors (cm)Tumor extent from incisions (cm)Previous treatment
160/MSquamous cellEsophagus1517-22None
272/FSquamous cellEsophagus1720-21None
365/FSquamous cellEsophagus1618-24Radiotherapy

RESULTS

Stents were successfully deployed all eight patients (Table 2), but in one case the stent migrated into the distal part of the esophagus.

. Procedural parameters

No.Prior dilationStent type and diameter (mm)Technical successImmediate complicationsDelayedcomplications
1NonePartially covered Ultraflex, 18 mmYesNoneTumor overgrowth
2NoneUncovered Wallstent, 16 mmYesNoneNone
3NoneUncovered Wallstent, 16 mmYesNoneNone
4NoneUncovered Ultraflex, 18 mmYesNoneEsophagorespiratory fistula
5NoneUncovered Wallstent,

DISCUSSION

Special technical considerations are required for the insertion of stents near the upper esophageal sphincter. Positioning of the stent is critical; stents placed too far proximally lie in the hypopharynx and are likely to cause a globus sensation. If the upper end of the stent is placed too far below the upper esophageal sphincter, subsequent tumor overgrowth creates a new problem because tumor tissue is located in the sphincter where it is difficult to treat with laser therapy. We placed the

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From the Krankenhaus Neukölln, Berlin Germany; University of Wisconsin Medical School, Milwaukee, Wisconsin.

☆☆

Reprint requests: Norbert Bethge, MD, Innere Medizin IV, Krankenhaus Neukölln, Rudower Strasse 48, D-12313 Berlin, Germany.

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