First Use of the Evolution® Esophageal Stent in the U.S

Abstract

Purpose: The Evolution® stent from Cook Medical is the first esophageal stent with a controlled release delivery system that allows deployment and recapturability with precision. Using a trigger-based introducer a proportional length of the stent is deployed or recaptured with each squeeze. The nitinol stent has an internal and external silicone coating, designed to resist tumor ingrowth. We present to first use of the Evolution® stent in a patient with esophageal cancer in the U.S. Methods: A 70 year-old male with known stage IV esophageal cancer presented with symptoms of progressive dysphagia and weight loss despite palliative chemotherapy. Two months prior to admission the patient was found to have a 8 cm circumferential obstructing mass in the distal esophagus and underwent placement of a covered metal esophageal stent. Repeat upper endoscopy showed tumor progression as well as significant tumor ingrowth at both the proximal and distal uncovered portions of the prior stent. Results: A 25 mm × 15 cm Evolution® stent was carefully placed under fluoroscopic guidance, overlapping the prior stent as well as areas of tumor ingrowth. The total procedure time was twelve minutes. Proper positioning was confirmed using endoscopy and fluoroscopic images. After successful placement there was immediate symptomatic improvement and the patient was able to tolerate a modified diet. Conclusion: We present the first use of the new Evolution® stent in the U.S. in a patient with esophageal cancer. This new delivery system allows facile and precise deployment and recapturability. The novel dual-sided silicone coating may prevent future tumor tumor ingrowth. The Evolution stent is a promising tool in the management of esophageal cancer.Figure