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Eur J Cardiothorac Surg 2003;23:794-798
© 2003 Elsevier Science NL

The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas

Department of Thoracic Surgery, Medical Faculty of Akdeniz University, Gögüs Cerrahisi Anabilim Dali, 07070 Antalya, Turkey

Received 1 November 2002; received in revised form 26 December 2002; accepted 27 January 2003.

^* Corresponding author. Tel.: +90-242-227-4343/21120; fax: +90-242-227-8844
e-mail: sarper{at}med.akdeniz.edu.tr

Objectives: Esophageal strictures and esophagorespiratory fistulas are complications of malignant esophageal tumors, which are difficult to manage. The efficacy of self-expanding metal stents (SEMS) for palliation of malignant esophageal strictures and fistulas was investigated prospectively. Methods: Forty-three SEMS were inserted in 41 patients with malignant esophageal stricture or fistula. Our series included 32 men and nine women, of whom median age was 61.4 years. Twenty nine stents were inserted for stricture, ten for esophago-tracheal fistula, and four esophago-pleural fistula. Stents were inserted endoscopically under fluoroscopic control. Results: SEMS implantation was technically successful in 40 of 41 patients. A second stenting was needed in two patients. Median dysphagia score improved from 3.4 to 1.3. The covered SEMS was succesful in completely sealing 85.7% of the fistulas. Complication occurred in 11 (26.8%) patients. Especially in the case of tumor stenoses in the distal esophagus, complication rate was higher (44%). In total six patients (14.6%) died after stent placement during early postoperative period. Procedure-related mortality was 4.8% (2/41). Conclusions: We conclude that treatment of malignant esophageal obstructions, including esophagorespiratory fistulas, with SEMS is an alternative palliative procedure. Furthermore SEMS implantation seems more safe in the case of tumor stenoses locating in the middle esophagus.

Key Words: Malignant dysphagia • Esophagorespiratory fistula • Self-expandable metal stent

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