Feasibility, efficacy and safety of stent insertion as a palliative treatment for malignant strictures in the cervical segment of the esophagus and the hypopharynx
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50 % of esophageal cancers are inoperable at the time of diagnosis, and around 15 % involve the cervical esophagus. The hypopharynx is often involved by these malignancies as well. Palliation of cervical esophageal malignancies through stent insertion is considered limited due to technical challenges, poor patient tolerance and high complication rate. The aim of this study is to review our experience with stent insertion in the cervical segment of the esophagus and to evaluate outcome differences between stent insertions involving or sparing the hypopharynx.
We retrospectively reviewed data on 69 consecutive patients that underwent stent insertion for malignant strictures in the cervical esophagus at our Department. Patients were divided according to involvement or sparing of the lower hypopharynx. Dysphagia severity was measured with the Mellow–Pinkas scale before the procedure and on monthly follow-ups. Any complication and its management were recorded. The main outcome parameters were as follows: dysphagia improvement, rate of successful dysphagia palliation (i.e., a reduction of the score to 0 or 1 after stent insertion) and complication rate. Multivariable analysis was carried out to assess the influence of patient- and procedure-related factors on the outcome of the procedure.
Stent insertion was achieved in 100 % patients. At 4 weeks, dysphagia score improved from a median of 3–0 (p < 0.001), and a successful palliation was achieved in 76.8 % patients. The 30-day mortality rate was 14.5 %. Successful palliation throughout the follow-up was achieved in 72.9 % of the surviving patients. Complications occurred in 31.9 % patients. Dilation before stent insertion was associated with a less efficient short-term dysphagia palliation (OR 6.77, 95 % CI 1.46–31.29, p = 0.02).
Stent insertion is a safe and effective palliative treatment for malignant cervical esophageal strictures. Results are consistent even in patients with hypopharyngeal lesions. Dilation should be avoided before stent insertion.
KeywordsEsophageal neoplasms Esophageal sphincter, upper Palliative care Stents Endoscopy, gastrointestinal
Giorgio Battaglia, Alessandro Antonello, Francesco Cavallin, Francesca Giacomini, Stefano Realdon and Sauid Ishaq declare that they have no conflict of interest or financial ties to disclose.
- 8.Conigliaro R, Battaglia G, Repici A, De Pretis G, Ghezzo L, Bittinger M, Messmann H, Demarquay JF, Togni M, Blanchi S, Filiberti R, Conio M (2007) Polyflex stents for malignant oesophageal and oesophagogastric strictures: a prospective, multicentric study. Eur J Gastroenterol Hepatol 19:195–203PubMedCrossRefGoogle Scholar
- 17.Goldshmid S, Boyce HW Jr, Nord HJ, Brady PG (1988) Treatment of pharyngoesophageal stenosis by polyvinyl prosthesis. Am J Gastroenterol 83:513–518Google Scholar
- 19.Elefteriadis E, Kotzampassi K (2006) Endoprosthesis implantation at the pharyngo-esophageal level: problems, limitations and challenges. World J Gastroenterol 12(13):2103–2108Google Scholar
- 20.Bayratkar O, Bayratkar B, Atasoy D, Erenler I, Ozdemir IA, Boluk S, Bayraktar OU, Bayraktar A, Tortum OB, Yigitbasi R (2013) Covered self expandable metallic stents could be successful in the palliation of malignant esophageal strictures: preliminary report. Surg Laparosc Endosc Percutan Tech 23(2):e41–e44. doi: 10.1097/SLE.0b013e318275b35f CrossRefGoogle Scholar
- 34.Bergquist H, Johnsson E, Nyman J, Rylander H, Hammerlid E, Friesland S, Ejnell H, Lundell L, Ruth M (2012) Combined stent insertion and single high-dose brachytherapy in patients with advanced esophageal cancer—results of a prospective safety study. Dis Esophagus 25:410–415PubMedCrossRefGoogle Scholar
- 37.Hirdes MM, van Hooft JE, Wijrdeman HK, Hulshof MC, Fockens P, Reerink O, van Oijen MG, van der Tweel I, Vleggaar FP, Siersema PD (2012) Combination of biodegradable stent placement and single-dose brachytherapy is associated with an unacceptably high complication rate in the treatment of dysphagia from esophageal cancer. Gastrointest Endosc 76(2):267–274PubMedCrossRefGoogle Scholar