VHM04 The Use of Small Caliber Covered Self-Expandable Metal Stents for Palliation of Severe Malignant Dysphagia

Abstract

Self-expandable covered metal stents provide palliation for malignant dysphagia; however significant complication rates have been associated with currently available large diameter stents. We hypothesized that small caliber fully covered self-expandable metal stents (sccSEMS) would provide adequate palliation of dysphagia in the absence of major complications. Prospective observational study of patients presenting with severe malignant dysphagia from esophageal adenocarcinoma or squamous cell cancer. 38 sccSEMS with internal diameters ranging from 8 mm to 16 mm were placed in 23 patients with pre-stent luminal diameters of < 8 mm (n = 18) or 8-10 mm (n = 5). 8 tracheobronchial stents (shaft diameter 14 – 16 mm), 2 biliary stents (shaft diameter 8 – 10 mm), and 28 specially constructed esophageal stents (shaft diameter 12 – 16 mm) were placed. All stents were placed under direct endoscopic vision without fluoroscopic support. A small caliber pediatric endoscope (diameter 5.5mm) was used to traverse the malignant strictures in cases of near-total esophageal obstruction. The direct endoscopic placement of sccSEMS in patients presenting with severe malignant dysphagia was technically successful in all cases, significantly improved dysphagia scores, provided excellent durability, and resulted in no major complications. These small caliber stents may be viewed as an alternative to currently available stents in patients with severe malignant dysphagia.