7051 Esophageal stent placement without flouroscopy.

Abstract

Background: Esophageal cancer is common in southwestern Kenya, and palliative treatment options are limited for patients with advanced disease. One obstacle preventing use of esophageal stents in our region is lack of flouroscopy equipment. We developed a method for esophageal stent placement without flouroscopy. Methods: Patients with dysphagia due to unresectable esophageal cancer were offered stent placement. All patients had previously undergone endoscopic dilation of their esophageal tumor to at least 36 French. Expandable stents made of stainless steel wire (Wallstent II, Schneider) or knit from nitinol (Ultraflex, Microvasive) were used. Prior to stent placement an endoscope was passed through the tumor to the stomach, a guidewire was placed in the antrum, and the tumor's position and length were noted during endoscope withdrawal. A stent was passed over the guidewire and through the tumor, after marking the stent delivery catheter at the base of the stent's proximal flange with an indelible colored mark. The endoscope was then re-introduced into the proximal esophagus alongside the stent delivery catheter, and the catheter was positioned so that the colored mark was visible at the proximal edge of the tumor. Stent deployment was monitored endoscopically with the endoscope tip positioned proximal to the constrained stent. After stent deployment the endoscope was gently passed into or through the stent. Dysphagia scores were recorded before stent placement and at follow-up clinic visits, on a scale ranging from 4 (unable to swallow saliva) to 0 (no dysphagia). Results: Stent placement was attempted in 24 patients and was successful in all cases. Stainless steel stents were placed in 14 patients and nitinol stents in 10 patients. An endoscope could be passed immediately through the stent to the stomach in 19 patients, and in the remaining 5 patients endoscopic views from the mid-shaft of the stent confirmed adequate placement across the entire tumor. Mean dysphagia score was 3.4 prior to stent placement (n=24) and 0.2 after stent placement (n=13). There were no immediate complications of stent placement. One patient returned 10 weeks after stenting with recurrent dysphagia due to tumor growth over the proximal end of the stent, which was successfully treated with placement of a second stent. An additional patient developed reflux symptoms requiring medication. Conclusion: Expandable esophageal stents can be accurately, safely, and easily placed under direct endoscopic control, without flouroscopy.