7044 Endoscopic stenting for malignant dysphagia: longterm experience.

Abstract

Introduction . Insertion of expandable endoprosthesis is one of the methods of endoscopic palliation of inoperable malignant stenoses in the esophagus. We report our experience with expandable prosthesis and compare the current results with the results during the initial learning period. Methods . From 1/1996 till 10/1999, 48 patients with malignant dysphagia and unresectable disease were treated with an expandable coated prosthesis (Ultraflex, Boston Scientific). In 10 patients a broncho-esophageal fistula was present. The median age of the patients was 61 years (34-87). Therapeutic outcome was analysed (II) and compared with our previously reported results (I) (37 patients, treated from 1992 till 1996 (Gastrointest Endosc 1998 Oct; 48(4) 383-8)). Results . In the present series the procedure was succesfull in all patients and radiologic control showed good expansion of the prosthesis in all cases. The fistula were closed in all patients. There was one major complication (excessive bleeding) and 3 patients had minor complications (fever). During follow-up the endoprosthesis was patent in all patients until analysis or until death. In two patients tumor overgrowth was successfull palliated with laser therapy. One patient had fatal hematemesis 15 days after stent placement. The median survival of the patients was 64 days, six patients were still alive at the moment of analysis. Conclusions . The higher success rate and the low complication rate, compared with our previous results, are due to increasing experience of the physicians, to the better patient selection and to better stents. Although life expectancy is limited a well functioning prosthesis greatly improves quality of life.