Patient Tolerance of Cervical Esophageal Metallic Stents
Section snippets
MATERIALS AND METHODS
All esophageal stents were placed solely under fluoroscopic guidance using bony landmarks, contrast material injection, and visualization of the laryngeal airway. Endoscopic confirmation of proximity to the cricopharyngeus was provided in two patients, one female and one male. Both stents were placed at the superior endplate of the vertebral body of T1 and were subsequently identified approximately 1.5 cm from the cricopharyngeus during endoscopy. All lesions requiring the proximal extent of a
RESULTS
The study group consisted of nine women and 13 men, who ranged in age from 28 years to 79 years (median age, 63 years). Thirteen patients had intrinsic esophageal malignancy (biopsy-proved squamous carcinoma in 11, adenocarcinoma in two), seven patients had extrinsic esophageal compression (due to bronchogenic carcinoma in four and malignant nodal compression in three). These lesions were surgically irresectible based on the demonstration of local invasion or distant spread on contrast-enhanced
CASE REPORT
A 60-year-old woman was diagnosed with inoperable squamous carcinoma of the cervical esophagus in 1994. She was treated with radiation therapy and chemotherapy but, by December 1995, had a dysphagia score of 3. She was managed by placement of an 18-mm uncovered Ultraflex stent, with its proximal extent at the inferior endplate of C5 (Figure). She was unaware of foreign-body sensation and her dysphagia score increased to 1. She required no further intervention and died of widespread metastatic
DISCUSSION
There are two randomized controlled trials comparing metallic and plastic prostheses in patients with malignant dysphagia (18, 19). In addition, several series report the deployment of various types of metallic stents. The evidence available to date suggests that metallic stents have an established role in the palliation of malignant esophageal strictures and in tracheoesophageal fistulas (13, 16, 20, 24).
Several series report a high technical success for placement of metallic stents, with
LIMITATIONS
This was a retrospective observational study; clearly, a prospective study would have been more robust. The sample size is small and different stents were used according to operator preference. In addition, we have no information about exclusions from the study (ie, those patients who were not referred to the interventional radiological service).
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Management of a cervical tracheoesophageal fistula with a modified self-expanding metal stent: Report of a case
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2011, Gastrointestinal EndoscopyEndoscopic Palliation of Malignant Dysphagia and Esophageal Fistulas
2011, Clinical Gastrointestinal Endoscopy, Second EditionEsophageal stents for malignant strictures close to the upper esophageal sphincter
2007, Gastrointestinal EndoscopyCovered Metallic Stent Placement in the Management of Cervical Esophageal Strictures
2007, Journal of Vascular and Interventional RadiologyCitation Excerpt :Given the tortuous nature of the cervical esophagus, stent flexibility and concomitant ability to conform to the demands of head/neck movement are crucial for patient comfort. Moreover, the complex sensory innervation of the pharyngeal mucosa makes high stent placement particularly sensitive to excessive stent pressure (16). Therefore, low radial force is important for minimizing the foreign body sensation or pain that results from undue mucosa pressure stemming from the expansile force of the stent.
Endoscopic Management of the Difficult Benign Esophageal Stricture
2007, Techniques in Gastrointestinal EndoscopyCitation Excerpt :Studies of stents in this area have consisted mostly of malignant strictures, and stents have alleviated effectively symptoms in this group of patients.50,51 Even when the proximal end of the stent was at the cervical esophagus or hypopharynx, these stents were surprisingly well tolerated.51 In Evrard’s25 study of the Polyflex stent in benign conditions, eight patients had strictures in the proximal esophagus.