Treatment Of Malignant Esophageal Strictures Research Articles

Localized Photodynamic Therapy Using a Chlorin e6-Embedded Silicone-Covered Self-Expandable Metallic Stent as a Palliative Treatment for Malignant Esophageal Strictures.

Localized photodynamic therapy (PDT) uses a polymeric-photosensitizer (PS)-embedded, covered self-expandable metallic stent (SEMS). PDT is minimally invasive and a noteworthy potential alternative for treating esophageal strictures, where surgery is not a viable option. However, preclinical evidence is insufficient, and optimized irradiation energy dose ranges for localized PDT are unclear. Herein, we validated the irradiation energy doses of the SEMS (embedded in a PS using chlorin e6 [Ce6] and covered in silicone) and PDT-induced tissue changes in a rat esophagus. Cytotoxicity and phototoxicity in the Ce6-embedded SEMS piece with laser irradiation were significantly higher than that of the silicone-covered SEMS with or without laser and the Ce6-embedded silicone-covered SEMS without laser groups (all p < 0.001). Moreover, surface morphology, atomic changes, and homogeneous coverage of the Ce6-embedded silicone-covered membrane were confirmed. The ablation range of the porcine liver was proportionally increased with the irradiation dose (all p < 0.001). The ablation region was identified at different irradiation energy doses of 50, 100, 200, and 400 J/cm2. The in vivo study in the rat esophagus comprised a control group and 100, 200, and 400 J/cm2 energy-dose groups. Finally, histology and immunohistochemistry (TUNEL and Ki67) confirmed that the optimized Ce6-embedded silicone-covered SEMS with selected irradiation energy doses (200 and 400 J/cm2) effectively damaged the esophageal tissue without ductal perforation. The polymeric PS-embedded silicone-covered SEMS can be easily placed via a minimally invasive approach and represents a promising new approach for the palliative treatment of malignant esophageal strictures.

Su1502 A New Fully Covered Metal Stent (Hanaro-Utrecht Stent) for the Treatment of Malignant Esophageal Strictures: a Prospective Follow-up Study

Placement of self-expandable metal stents (SEMS) provides effective palliation in patients with malignant dysphagia. Although fully covered SEMS are increasingly used to prevent tissue ingrowth, they are prone to migrate. To reduce migration risk, we developed the HANARO-Utrecht stent, a new fully covered 20-mm SEMS which combines bilateral flared ends and three rows of anchoring flaps on the stent body for the prevention of migration.

İnoperabl Malign Özofagus Darlıklarının Kendiliğinden Genişleyebilen Metalik Stentlerle Palyatif Tedavisi: Tek Merkezli 155 Hastalık Deneyim

Objective: A retrospective study was designed to investigate the success and the complication rates of different types of self-expandable metallic stents in patients with inoperable malignant esophageal strictures. Material and Methods: One hundred fifty five patients with malignant esophageal strictures received self-expandable metallic stents under fluoroscopic guidance in our clinic between the years 1994 and 2008. A total of 137 men and 18 women aged between 26- 83 years (mean age, 58.9 years) were included in the study. Stent types used include Strecker, Wallstent, covered Wallstent, Flamingo Wallstent, Choo Stent and Song Stent. Complications of different stent types and dysphagia scores of the patients were evaluated both prior to the stent placement and afterwards. Results: Stent delivery tecnique was successful in all patients. The average dysphagia score decreased from 3.1 (dysphagia to liquids) to 1.2 (dysphagia to normal solid food) providing a 1.9 improvement in the dysphagia score. In eight cases (5.2%) early complications such as malposition and early migration were detected. In 30 cases (19.4%) late complications such as ingrowth, overgrowth, coexistence of ingrowth and overgrowth, late migration, esophago-bronchial fistula and bleeding were detected. Conclusion: Placement of self-expandable metallic stents in the palliative treatment of malignant esophageal strictures is an easily applied, well-tolerated and effective method which improves the dysphagia score of the patients with low complication rates. Our results are in agreement with the literature. The selection of the ideal stent for each patient is of great importance.

Double-Layered PTFE-Covered Nitinol Stents: Experience in 32 Patients with Malignant Esophageal Strictures

We evaluated the effectiveness of a double-layered polytetrafluoroethylene (PTFE)-covered nitinol stent in the palliative treatment of malignant esophageal strictures. A double-layered PTFE-covered nitinol stent was designed to reduce the propensity to migration of conventional covered stent. The stent consists of an inner PTFE-covered stent and an outer uncovered nitinol stent tube. With fluoroscopic guidance, the stent was placed in 32 consecutive patients with malignant esophageal strictures. During the follow-up period, the technical and clinical success rates, complications, and cumulative patient survival and stent patency were evaluated. Stent placement was technically successful in all patients, and no procedural complications occurred. After stent placement, the symptoms of 30 patients (94%) showed improvement. During the mean follow-up of 103 days (range, 9-348 days), 11 (34%) of 32 patients developed recurrent symptoms due to tumor overgrowth in five patients (16%), tumor ingrowth owing to detachment of the covering material (PTFE) apart from the stent wire in 3 (9%), mucosal hyperplasia in 2 (6%), and stent migration in 1 (3%). Ten of these 11 patients were treated by means of placing a second covered stent. Thirty patients died, 29 as a result of disease progression and 1 from aspiration pneumonia. The median survival period was 92 days. The median period of primary stent patency was 190 days. The double-layered PTFE-covered nitinol stent seems to be effective for the palliative treatment of malignant esophageal strictures. We believe that the double-layer configuration of this stent can contribute to decreasing the stent's migration rate.

A Covered Nitinol Stent Fracture in a Patient with a Malignant Esophageal Stricture: A Case Report

Self-expanding metallic stent insertion has been widely applied for the palliative treatment of malignant esophageal strictures. Although it is known as an easy, safe, and effective procedure, complications are well known and include things such as stent migration and esophageal stent occlusion caused by tumor ingrowth. However, metallic stent fractures have been rarely reported in the esophagus, especially for nitinol stents. We report a case of a stent fracture associated with migration in a patient with a malignant esophageal stricture near the gastroesophageal junction. It is highly probable that the stent fracture was due to chemical erosion of the stent caused by gastric juice.

Periodic endoscopic observation of postoperative esophageal stricture due to excessive tissue hyperproliferation after stent placement

Since Domschke et al.1 reported the first successful treatment of malignant esophageal strictures with an expandable metallic stent in 1990, such stents have been used for palliation of patients with dysphagia caused by malignant esophageal strictures. The few reports of expandable stent placement for benign esophageal strictures indicate that the complication rate is high.2,3 The problem is the frequent occurrence of tissue hyperproliferation and resultant esophageal obstruction. However, little is known about how and when tissue hyperproliferation occurs or how it can be treated. This article reports periodic endoscopic findings in 2 patients with tissue hyperproliferation after stent placement.

Preliminary experience with a new ultraviolet-cured expandable plastic endoprosthesis in the management of malignant esophageal strictures.

Different types of expandable metal stent are currently available for the palliative treatment of malignant esophageal strictures. To overcome some of the disadvantages involved in the design of metal mesh stents, we designed a balloon-expanded plastic endoprosthesis, which is hardened by irradiation with ultraviolet light after deployment. We present here our preliminary results. From April 1995 to January 1996, four patients with unresectable esophageal malignancies were treated with this stent. Insertion of the stent was the only palliative procedure carried out. The patients were followed up until death. Stent placement was successful in all patients, and no procedure-related complications occurred. Dysphagia was reduced from an average score of 2.6 to 1.0. Early complications included retrosternal pain of limited duration in one patient. One patient died 72 hours after uncomplicated stent placement, due to cardiac arrhythmia. Late complications were limited to tumor overgrowth in two patients, after a mean of 104 days. The stent patency rate averaged 92 days. In patients with a malignant esophageal stricture, this newly developed expandable endoprosthesis is effective in relieving dysphagia. The deployment of the stent is easy and safe. The endoprosthesis has potential advantage over current expandable metal mesh stents.