A prospective trial of self-expanding metal stents in the palliation of malignant esophageal strictures near the upper esophageal sphincter☆,☆☆,★
Section snippets
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).Number Age (yr)/Sex Cancerous tumor type Location Upper sphincter from incisors (cm) Tumor extent from incisions (cm) Previous treatment 1 60/M Squamous cell Esophagus 15 17-22 None 2 72/F Squamous cell Esophagus 17 20-21 None 3 65/F Squamous cell Esophagus 16 18-24 Radiotherapy
RESULTS
Stents were successfully deployed all eight patients (Table 2), but in one case the stent migrated into the distal part of the esophagus.No. Prior dilation Stent type and diameter (mm) Technical success Immediate complications Delayedcomplications 1 None Partially covered Ultraflex, 18 mm Yes None Tumor overgrowth 2 None Uncovered Wallstent, 16 mm Yes None None 3 None Uncovered Wallstent, 16 mm Yes None None 4 None Uncovered Ultraflex, 18 mm Yes None Esophagorespiratory fistula 5 None Uncovered 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.
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Reprint requests: Norbert Bethge, MD, Innere Medizin IV, Krankenhaus Neukölln, Rudower Strasse 48, D-12313 Berlin, Germany.
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