Placement of Self-Expandable Esophageal Metallic Stents: Is Fluoroscopy Necessary?

Abstract

Purpose: Self Expandable Metallic Stents (SEMS) are an important method to achieve palliation in the setting of esophageal cancer. Although the placement of self-expanding metal stents (SEMS) is usually performed with fluoroscopic control (FC), it seems there is no difference in its placement only with endoscopic control (EC). However, comparative studies are lacking. The purpose of this study was to compare the efficacy and safety of placing SEMS under FC or only EC. Methods: Retrospective review of 126 consecutive patients who underwent placement of SEMS for malignant dysphagia between January 2005 and February 2010, evaluating: epidemiological data, previous treatment, procedure performed, acute complications (pain, vomiting, bleeding, perforation and dysphagia occurring ≤30 days after insertion SEMS), chronic complications (tumor in/overgrowth, migration, hemorrhage, fistula, impaction and esophagitis occurring after > 30 days) and survival. Results: We placed 126 SEMP, 66 under FC and 60 under EC. Mean age was 61.8 years with ¾ of male patients. The indications were stenosis in 92.1% and esophagus-respiratory fistula in 7.9%. Acute complications occurred in 31 patients (47%) in the FC group and 25 patients (42%) in the EC group (p0,55): pain - FC 22 vs. EC 15 patients (p0,31); vomiting - FC 15 vs. EC 9 (p0,27); hemorrhage - FC 1 vs. EC 2 (p0,50); dysphagia - FC 2 vs. EC 3 (p 0.57). No perforations occurred in any group. Chronic complications occurred in 20 patients (30%) in the FC group and 22 patients (37%) in the EC group (p0,44): tumor in/overgrowth - FC 13 vs. EC 10 (p0,66); prostheses migration - FC 5 vs. EC 8 (p0,28); hemorrhage - FC 2 vs. EC 2 (p0,54); fistulae - FC 7 vs. EC 4 (p0,43); food impaction - FC 9 vs. EC 8 (p0,96), esophagitis - FC 12 vs. EC 15 (p0,35). Median survival was 111.7 days for patients in the FC group and 105 days for the EC group (p0,76). In 20% of the cases in the EC group, ultrathin endoscope was used to overcome severe stenosis. Conclusion: There were no statistical differences in the incidence of complications and survival between the two groups. These data are in line with the largest published study of SEMS insertion without fluoroscopic control. The placement of SEMS by endoscopic control is in our opinion an effective, fast, easily available method in any endoscopy unit and the use of an ultrathin endoscope is very important in some severe stenosis, which in turn diminishes the need for dilations.