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CardioVascular and Interventional Radiology

, Volume 28, Issue 3, pp 284–288 | Cite as

Quality Improvement Guidelines for Placement of Esophageal Stents

  • Tarun Sabharwal
  • Jose P. Morales
  • Farah G. Irani
  • Andreas Adam
Cirse Guidelines

Esophageal cancer is now the sixth leading cause of death from cancer worldwide [1, 2]. During the past three decades, important changes have occurred in the epidemiologic patterns associated with this disease [1]. Due to the distensible characteristics of the esophagus, patients may not recognize any symptoms until 50% of the luminal diameter is compromised, explaining why cancer of the esophagus is generally associated with late presentation and poor prognosis [3]. Esophageal cancer has a poor outcome, with an overall 5 year survival rate of less than 10%, and fewer than 50% of patients are suitable for resection at presentation. As a result palliation is the best option in this group of patients [3, 4]. The aims of palliation are maintenance of oral intake, minimizing hospital stay, relief of pain, elimination of reflux and regurgitation, and prevention of aspiration [3, 5, 6]. For palliative care, current treatment options include thermal ablation [7, 8, 9], photodynamic therapy [10, 11, 12], radiotherapy [13], chemotherapy [14, 15], chemical injection therapy [16, 17, 18], argon beam or bipolar electrocoagulation therapy [19], enteral feeding (nasogastric tube/percutaneous endoscopic gastrostomy) [20, 21, 22], and intubation (self-expanding metal stents (SEMS) or semi-rigid prosthetic tubes) [5, 6, 23, 24, 25, 26] with different success and complications rates.

Keywords

Stent Insertion Stent Migration Metallic Stents Covered Stents Tumor Ingrowth 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Enzinger, PC, Mayer, RJ 2003Medical progress: Esophageal cancerN Engl J Med34922412252CrossRefPubMedGoogle Scholar
  2. 2.
    Pisani, P, Parkin, DM, Bray, F,  et al. 1999Estimates of the worldwide mortality from 25 cancers in 1990Int J Cancer831829CrossRefPubMedGoogle Scholar
  3. 3.
    Kubba, AK, Krasner, N 2000An update in the palliative management of malignant dysphagiaEur J Surg Oncol26116129CrossRefPubMedGoogle Scholar
  4. 4.
    Mason, R 2001Palliation of oesophageal cancerSurg Oncol10123126CrossRefPubMedGoogle Scholar
  5. 5.
    Morgan, R, Adam, A 2001Esophageal stents: An updateSemin Interv Radiol18251264CrossRefGoogle Scholar
  6. 6.
    Lee, SH 2001The role of oesophageal stenting in the non-surgical management of oesophageal stricturesBr J Radiol74891900PubMedGoogle Scholar
  7. 7.
    Adam, A, Ellul, J, Watkinson, AF,  et al. 1997Palliation of inoperable esophageal carcinoma: A prospective randomised trial of laser therapy and stent placementRadiology202344348Google Scholar
  8. 8.
    Gevers, AM, Macken, E, Hiele, M,  et al. 1998A comparison of laser therapy, plastic stents and expandable metal stents for palliation of malignant dysphagia in patients without a fistulaGastrointest Endosc48383388PubMedGoogle Scholar
  9. 9.
    Tan, DS, Mason, RC, Adam, A,  et al. 1996Minimally invasive therapy for advanced oesophageal malignancyClin Radiol51828836PubMedGoogle Scholar
  10. 10.
    Heier, SK, Rothman, KA, Heier, LM,  et al. 1995Photodynamic therapy for obstructing oesophageal cancer: Light dosimetry and randomised comparisons with Nd:YAG laser therapyGastroenterology1096372PubMedGoogle Scholar
  11. 11.
    Lightdale, CJ, Heier, SK, Manon, ME 1995Photodynamic therapy with porfimer sodium versus thermal ablation with Nd:YAG laser for palliation of esophageal cancer: A multi-centre randomised trialGastrointest Endosc42507512PubMedGoogle Scholar
  12. 12.
    Luketich, JD, Christine, NA, Buenaventura, PO,  et al. 2000Endoscopic photodynamic therapy for obstructing oesophageal cancer: 77 cases over a 2 year periodSurg Endosc14653657CrossRefPubMedGoogle Scholar
  13. 13.
    Earlam, R, Cunha-Melo, JR 1980Oesophageal squamous cell carcinoma. A critical review of radiotherapyBr J Surg67457461PubMedGoogle Scholar
  14. 14.
    Bamias, A, Hill, M, Cunningham, D,  et al. 1996Epirubicin, cisplatin and protracted venous infusional 5 fluorouracil for oesophagogastric adenocarcinoma: Response, toxicity, quality of life and survivalCancer7719781985Google Scholar
  15. 15.
    Highley, M, Parnis, F, Trotter, GA,  et al. 1994Combination chemotherapy with epirubicin, cisplatin and 5-fluorouracil for the palliation of advanced gastric and oesophageal adenocarcinomaBr J Surg8117631765PubMedGoogle Scholar
  16. 16.
    Nwokolo, LU, Payne-James, JJ, Silk, DBA,  et al. 1994Palliation of malignant dysphagia by ethanol induced tumour necrosisGut35299303PubMedGoogle Scholar
  17. 17.
    Payne-James, JJ, Spiller, RC, Misiewicz, JJ 1990Use of ethanol induced tumour necrosis to palliate dysphagia in patients with esophagogastric cancerGastrointest Endosc364346PubMedGoogle Scholar
  18. 18.
    Chung, SCS, Leong, HT, Choi, CYC 1994Palliation of malignant esophageal obstruction by endoscopic alcohol injectionEndoscopy26275277PubMedGoogle Scholar
  19. 19.
    Heindorff, H, Wojdemann, M, Bisgaard, T,  et al. 1998Endoscopic palliation of inoperable cancer of the esophagus or cardia by organ electrocoagulationScand J Gastroenterol332123PubMedGoogle Scholar
  20. 20.
    Mekhail, TM, Adelstein, DJ, Rybicki, LA,  et al. 2001Enteral nutrition during the treatment of head and neck carcinoma: Is a percutaneous endoscopic gastrostomy tube preferable to nasogastric tube?Cancer9117851790Google Scholar
  21. 21.
    Magne, N, Marcy, PY, Foa, C,  et al. 2001Comparison between nasogastric tube feeding and percutaneous fluoroscopic gastrostomy in advanced head and neck cancer patientsEur Arch Otorhinolaryngol2588992CrossRefPubMedGoogle Scholar
  22. 22.
    Ripamonti, C, Gemlo, BT, Bozzetti, F,  et al. 1996Role of enteral nutrition in advanced cancer patients: Indications and contraindications of the different techniques employedTumori82302308PubMedGoogle Scholar
  23. 23.
    O’Donell, CA, Fullarton, GM, Watt, E,  et al. 2002Randomized clinical trial comparing self-expanding metallic stents with plastic endoprostheses in the palliation of oesophageal cancerBr J Surg89985992CrossRefPubMedGoogle Scholar
  24. 24.
    Mosca, F, Consoli, A, Stracqualursi, A,  et al. 2003Comparative retrospective study on the use of plastic prostheses and self-expanding metal stents in the palliative treatment of malignant strictures of the esophagus and cardiaDis Esoph16119125CrossRefGoogle Scholar
  25. 25.
    Palma, GD, di Matteo, E, Romano, E,  et al. 1996Plastic prosthesis versus expandable metal stents for palliation of inoperable oesophageal thoracic carcinoma: A controlled prospective studyGastrointest Endosc43478482PubMedGoogle Scholar
  26. 26.
    Cwikiel, W, Tranberg, KG, Cwikiel, M,  et al. 1998Malignant dysphagia: Palliation with oesophageal stents—long term results in 100 patientsRadiology207513518Google Scholar
  27. 27.
    Symonds, CJ 1885A case of malignant stricture of the oesophagus illustrating the use of a new form of oesophageal catheterTrans Clin Soc Lond18155158Google Scholar
  28. 28.
    Acunas, B, Rozanes, I, Akpinar, S,  et al. 1996Palliation of malignant esophageal strictures with self-expanding Nitinol stents: Drawbacks and complicationsRadiology199648652Google Scholar
  29. 29.
    Laasch, HU, Nicholson, DA, Kay, CL,  et al. 1998The clinical effectiveness of the Gianturco oesophageal stent in malignant oesophageal obstructionClin Radiol53666672PubMedGoogle Scholar
  30. 30.
    Morgan, RA, Denton, ERE, Watkinson, AF,  et al. 1996Metallic stenting of malignant esophageal strictures (abstract)Cardiovasc Intervent Radiol1969Google Scholar
  31. 31.
    Song, HY, Do, YS, Han, YM,  et al. 1998Covered, expandable oesophageal metallic stent tubes: Experience in 119 patientsRadiology207513518PubMedGoogle Scholar
  32. 32.
    Watkinson, AF, Ellul, J, Entwistle, K,  et al. 1995Plastic-covered metallic endoprostheses in the management of esophageal perforation in patients with esophageal carcinomaClin Radiol50304309PubMedGoogle Scholar
  33. 33.
    Do, YS, Song, HY, Lee, BH,  et al. 1993Esophagorespiratory fistula associated with esophageal cancer: Treatment with a Gianturco stent tubeRadiology187673677Google Scholar
  34. 34.
    Gupta, NK, Boylan, CE, Razzaq, R,  et al. 1999Self expanding oesophageal metal stents for the palliation of dysphagia due to extrinsic compressionEur Radiol918931897CrossRefPubMedGoogle Scholar
  35. 35.
    Saxon, RR, Barton, RE, Rösch, J 1994Complications of oesophageal stenting and balloon dilatationSemin Interv Radiol11276282Google Scholar
  36. 36.
    Faruggia, M, Morgan, RA, Latham, JA,  et al. 1997Perforation of the esophagus secondary to insertion of covered Wallstent endoprosthesesCardiovasc Intervent Radiol20428430Google Scholar
  37. 37.
    Tyrell, M, Trotter, G, Adam, A,  et al. 1995Incidence and management of laser-associated oesophageal perforationBr J Surg8212571258PubMedGoogle Scholar
  38. 38.
    Broto, J, Asensio, M, Vernet, JM 2003Results of a new technique in the treatment of severe esophageal stenosis in children: Polyflex stentsJ Pediatr Gastroent Nutr37203206CrossRefGoogle Scholar
  39. 39.
    Nishimura, Y, Nagata, K, Katano, S,  et al. 2003Severe complications in advanced esophageal cancer treated with radiotherapy after intubation of esophageal stents: A questionnaire survey of the Japanese Society for Esophageal DiseasesInt J Radiat Oncol Biol Phys5613271332CrossRefPubMedGoogle Scholar
  40. 40.
    Yakami, M, Mitsumori, M, Sai, H,  et al. 2003Development of severe complications caused by stent placement followed by definitive radiation therapy for T4 esophageal cancerInt J Clin Oncol8395398CrossRefPubMedGoogle Scholar
  41. 41.
    Watkinson, AF, Ellul, J, Entwisle, K,  et al. 1995Oesophageal carcinoma: Initial results of palliative treatment with covered self-expanding endoprosthesesRadiology195821827Google Scholar
  42. 42.
    Schamassmann, A, Meyenberger, C, Knuchel, J,  et al. 1997Self-expanding metal stents in malignant esophageal obstruction: A comparison between two stents typesAm J Gastroenterol92400406PubMedGoogle Scholar
  43. 43.
    Raijman, I, Siddiqui, I, Ajani, J,  et al. 1998Palliation of malignant dysphagia and fistulae with coated expandable metal stents: Experience with 101 patientsGastrointest Endosc48172179PubMedGoogle Scholar
  44. 44.
    Winkelbauer, FW, Schofl, R, Niederle, B,  et al. 1996Palliative treatment of obstructing esophageal cancer with nitinol stents: Value, safety, and long-term resultsAJR Am J Roentgenol1667984PubMedGoogle Scholar
  45. 45.
    O’Sullivan, GJ, Grundy, A 1999Palliation of malignant dysphagia with expanding metal stentsJ Vasc Interv Radiol10346351PubMedGoogle Scholar
  46. 46.
    Roseveare, CD, Patel, P, Simmonds, N,  et al. 1998Metal stents improve dysphagia, nutrition and survival in malignant oesophageal stenosis: A randomised controlled trial comparing modified Gianturco Z stents with plastic Atkinson tubesEur J Gastroenterol Hepatol10653657PubMedGoogle Scholar
  47. 47.
    Siersema, PD, Hop, CJ, Dees, J,  et al. 1998Coated self-expanding stent versus latex prostheses for esophagogastric cancer with special reference to prior radiation and chemotherapy: A controlled prospective studyGastrointest Endosc46113119Google Scholar
  48. 48.
    Kozarek, R, Raltz, S, Brugge, WR,  et al. 1996Prospective multicentre trial of oesophageal Z-stent placement for malignant dysphagia and tracheoesophageal fistulaGastrointest Endosc44562567PubMedGoogle Scholar
  49. 49.
    Wengrower, D, Fiorini, A, Valero, J,  et al. 1998Esophacoil: Long term results in 81 patientsGastrointest Endosc48376382PubMedGoogle Scholar
  50. 50.
    Olsen, E, Thyregaard, R, Kill, J,  et al. 1999Esophageal expanding stent in the management of patients with non-resectable malignant esophageal or cardiac neoplasm: A prospective studyEndosc31417420CrossRefGoogle Scholar
  51. 51.
    Dua, KS, Kozarek, R, Kim, J,  et al. 2001Self expanding metal esophageal stent with anti-reflux mechanismGastrointest Endosc53603613CrossRefPubMedGoogle Scholar
  52. 52.
    Song, HY, Jung, HY, Park, SI,  et al. 2000Covered retrievable expandable Nitinol stents in patients with benign esophageal strictures: Initial experienceRadiology217551557Google Scholar
  53. 53.
    Bartelsman, JF, Bruno, MJ, Jensema, AJ,  et al. 2000Palliation of patients with esophagogastric neoplasm by insertion of a covered expandable modified Gianturco-Z endoprosthesis: Experiences in 153 patientsGastrointest Endosc51134138PubMedGoogle Scholar
  54. 54.
    Song, HY, Park, SI, Jung, HY,  et al. 1997Benign and malignant esophageal strictures: Treatment with a polyurethane-covered retrievable expandable metallic stentRadiology203747752Google Scholar
  55. 55.
    Costamagna, G, Shak, SK, Tringali, A,  et al. 2003Prospective evaluation of a new self-expanding plastic stent for inoperable esophageal stricturesSurg Endosc17891895CrossRefPubMedGoogle Scholar
  56. 56.
    Dormann, AJ, Eisandrath, P, Wigginghaus, B,  et al. 2003Palliation of esophageal carcinoma with a new self-expanding plastic stentEndoscopy35207211CrossRefPubMedGoogle Scholar
  57. 57.
    Adam, A, Morgan, R, Ellul, J,  et al. 1998A new design of the esophageal Wallstent endoprosthesis resistant to distal migrationAJR Am J Roentgenol17014771482PubMedGoogle Scholar
  58. 58.
    Sabharwal, T, Hamady, MS, Chui, S,  et al. 2003A randomized prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinomaGut5292226CrossRefPubMedGoogle Scholar
  59. 59.
    Kocher, M, Dlouhy, M, Neoral, C,  et al. 1998Esophageal stent with antireflux valve for tumors involving the cardia: Work in progressJ Vasc Interv Radiol910071010PubMedGoogle Scholar
  60. 60.
    Nicholson, AA, Royston, CMS, Wedgewood, K,  et al. 1995Palliation of malignant oesophageal perforation and proximal oesophageal malignant dysphagia with covered metal stentsClin Radiol501114PubMedGoogle Scholar
  61. 61.
    Morgan, RA, Ellul, JPM, Denton, ERE,  et al. 1997Malignant esophageal fistulas and perforations: Management with plastic-covered metallic endoprosthesesRadiology204527532Google Scholar
  62. 62.
    Sabharwal, T, Morales, JP, Salter, R,  et al. 2004Esophageal cancer: Self-expanding metallic stentsAbdom Imaging2919Google Scholar
  63. 63.
    Mayoral, W, Fleischer, D, Salcedo, J,  et al. 2000Non-malignant obstruction is a common problem with metal stents in the treatment of oesophageal cancerGastrointest Endosc51556559CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Tarun Sabharwal
    • 1
  • Jose P. Morales
    • 1
  • Farah G. Irani
    • 1
  • Andreas Adam
    • 1
  1. 1.Department of Interventional RadiologyGuy’s and St. Thomas’ Hospital TrustLondonUK

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