Abstract
Esophageal stent implantation is an alternative for microjejunostomy or total parenteral nutrition in the palliative treatment of malignant dysphagia in the course of esophageal and advanced bronchial cancers infiltrating the esophagus. The procedure of implanting an esophageal self-expanding metal stent (SEMS) is performed with gastroscopic guidance under general anesthesia. To analyze the efficacy and safety of a simplified technique (without gastroscopic guidance in local anesthesia) of esophageal SEMS implantation in patients with malignant dysphagia in the course of esophageal and bronchial cancers. This is a retrospective analysis of consecutive procedures of uncovered esophageal SEMS implantation performed with a simplified adaptation of the endovascular technique (Seldinger wire) in patients with esophageal and bronchial cancers and poor performance status. The procedures were done in a single surgical center over an 8-year period in 27 patients who were referred from oncology departments with esophageal stenosis confirmed using gastroscopy and who were being treated for malignant dysphagia. The study endpoints were effectiveness (a decrease in dysphagia from grade 3 or 4 to grade 1 after the procedure) and complications related to the procedures (including restenosis and stent migration). In all 27 patients, the SEMS were effectively implanted, enabling enteral nutrition after the procedure. No early complications related to the procedure were observed. A single patient developed restenosis 14 days after the procedure, which required re-stenting. The simplified method for SEMS implantation described herein may be considered an option in the palliative treatment of patients with malignant dysphagia in the course of esophageal and bronchial cancers and poor performance status, especially in facilities with limited access to endoscopy.
Highlights
Dysphagia caused by cancer is a common and severe complication of locally advanced, unresectable or recurring cancers of the gastro-esophageal junction, and much less frequently from infiltration of bronchial carcinomas
The simplified method for self-expanding metal stent (SEMS) implantation described may be considered an option in the palliative treatment of patients with malignant dysphagia in the course of esophageal and bronchial cancers and poor performance status, especially in facilities with limited access to endoscopy
Between 2010 and 2017, 28 patients with esophageal stenosis and dysphagia who were in the course of advanced esophageal and bronchial cancers confirmed using gastroscopy, and who were disqualified from chemo- and radiotherapy due to poor performance status (Eastern Cooperative Oncology Group performance status 3 or 4), were referred from oncology centers to the Department General and Vascular Surgery
Summary
Dysphagia caused by cancer is a common and severe complication of locally advanced, unresectable or recurring cancers of the gastro-esophageal junction, and much less frequently from infiltration of bronchial carcinomas. It is followed by the rapid development of cachexia, which affects the quality of life and overall patient survival.[1,2]. Malnutrition can be reduced either by enteral nutrition through a jejunostomy or total parenteral nutrition. Neither of these procedures resolves the problem of the patient’s inability to swallow saliva, which leads to the severe complication of saliva aspirating into the airway. The procedure of implanting an esophageal self-expanding metal stent (SEMS) is performed with gastroscopic guidance under general anesthesia
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