Cryotherapy with Uncovered Metal Stent for Palliation of Obstructive Esophageal Cancer

Abstract

Purpose: This is a case report of palliation of dysphagia from obstructive esophagus cancer using an uncovered metal stent to avoid migration and to allow access for cryotherapy to the tumor. An 85 year old male presented 2 years ago with dysphagia due to obstructing lower esophageal adenocarcinoma. He was not a candidate for surgery and refused chemoradiation therapy. His dysphagia was treated with multiple courses of cryotherapy and dilation. However his esophagus stricture progressed. Additionally, the distal portion of the tumor could not be reached with cryotherapy due to the esophageal obstruction. Furthermore, two attempts of fully covered metal stents placement were complicated with migration to the stomach. After obtaining informed consent, we placed an uncovered metal stent across the tumor (Figure 1). One week after expansion of the stent, cryotherapy was performed using C02 system with 0.005 inch forward-firing flexible catheter, gas flow (6-8 liters/minute), 10-15 seconds of ice effect x 4 applications with thaw (Figure 2). Cryotherapy was able to be delivered to tumor through the uncovered stent. Subsequently, cryotherapy was repeated every 6 to 8 weeks The stent provided rapid relief of dysphagia. The ingrowth of tumor was controlled with cryotherapy. Patient gained 10 pounds and has been symptom free for six months since placement of the uncovered metal stent. For patients with inoperable obstructing esophageal cancer, who are not candidates for standard therapy, combined approach of using uncovered metal stent and cryotherapy provides immediate dysphagia relief and access for continued cryotherapy. A clinical trial using this technique is warranted (we are initiating a cryo/stent trial).Figure: No Caption available.Figure: No Caption available.