Esophageal Stents for Palliation of Malignant Dysphagia Due to Extrinsic Compression

Abstract

Background: Surprisingly little is known about placement of metal stents in patients with malignant dysphagia due to extrinsic compression on the esophageal wall. Aim: To determine efficacy and safety of covered stent placement in this group of patients. Methods: From January 1996 to August 2007, 39 patients (mean age: 66 yr; 25 males) with malignant dysphagia due to extrinsic compression from metastatic lung cancer (n = 21), esophageal cancer following resection (n = 10), breast cancer (n = 5) or other causes (n = 3) were treated with a covered metal stent. Seven (18%) patients also had a tracheo-esophageal fistula. Functional and technical outcome, survival, complications and recurrent dysphagia were analyzed with chi-square testing and Kaplan-Meier curves. Results: The procedure was technically successful in 37/39 (95%) patients. Fistula sealing was achieved in all patients. After 4 weeks, dysphagia had improved from a median score of 3 (liquids only) to 1 (some difficulties with solids). Total complications were seen in 13/39 (33%) patients. Of these, major complications occurred in 8/39 (21%) patients and consisted of perforation (3) aspiration pneumonia (2), hemorrhage (2), fistula (1), and fever (1). Minor complications, such as pain (n = 4) and symptomatic gastro-esophageal reflux (n = 3), were observed in 6/39 (15%) patients. Recurrent dysphagia occurred in 5 (13%) patients and was due to food impaction (n = 3), tissue in- or overgrowth (n = 2), stent migration (1), or other reasons (n = 2). Median survival after stent placement was 46 days. Thirteen (33%) patients died within 30 days after treatment. Conclusions: Stent placement is relatively safe and effective for the palliation of dysphagia in patients with extrinsic malignant compression. The decision to place a stent should, however, be balanced against the relatively poor prognosis of patients with metastatic disease.