nitinol and Carcinoma--Squamous-Cell

Radiotherapy, chemotherapy and self-expanding nitinol stent insertion were performed in patients with inoperable esophageal cancer to improve oral ingestion. Twelve patients underwent radiotherapy and chemotherapy. A stent was inserted in patients with dysphagia after radiotherapy and chemotherapy. Patients' capacity for oral ingestion was classified into three categories: grade I patients were able to ingest enough food; grade II patients could ingest food but required nutritional support; and grade II patients found it impossible to ingest anything. After radiotherapy and chemotherapy, the number of grade I patients increased from three to five but seven patients remained in grades II and III. Four grade II and III patients were treated with stents, after which dysphagia was reduced to grade I. In the grade I patients after treatment with radiotherapy and chemotherapy, the duration of grade I was on average 167 days and survival was 191 days. In the patients subjected to stent insertion, grade I lasted 65 days and survival was 149 days. Before the introduction of the stent, grade II patients died, on average, after 91 days. After the introduction of self-expanding nitinol stents, all patients could ingest enough food and were discharged.

Topics: Aged; Aged, 80 and over; Alloys; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Squamous Cell; Combined Modality Therapy; Deglutition; Deglutition Disorders; Eating; Esophageal Neoplasms; Female; Humans; Male; Middle Aged; Palliative Care; Radiotherapy; Stents; Survival Rate; Treatment Outcome

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Alloys; Biocompatible Materials; Carcinoma, Squamous Cell; Equipment Design; Equipment Safety; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Female; Humans; Male; Middle Aged; Palliative Care; Stents; Treatment Outcome

Topics: Airway Obstruction; Alloys; Bronchial Diseases; Bronchoscopy; Carcinoma, Squamous Cell; Constriction, Pathologic; Humans; Laser Therapy; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Predictive Value of Tests; Prosthesis Design; Stents; Tomography, X-Ray Computed; Tracheal Stenosis; Treatment Outcome

Placement of a single new-generation nitinol stent resulted in acute pericardial tamponade in a 70-year-old man with superior vena cava syndrome.

Topics: Acute Disease; Aged; Alloys; Angioplasty, Balloon; Carcinoma, Squamous Cell; Cardiac Tamponade; Electrocardiography; Hemodynamics; Humans; Lung Neoplasms; Male; Pericardiocentesis; Phlebography; Prosthesis Design; Stents; Superior Vena Cava Syndrome; Tomography, X-Ray Computed; Treatment Outcome

A 60-year-old man with esophageal carcinoma in the upper 3rd underwent palliative treatment including photodynamic therapy, brachytherapy, external beam irradiation, and esophageal stenting. He developed a symptomatic malignant esophagotracheo-bronchial fistula that could not be closed by telescope-stenting in the esophagus. Implantation of a self-expanding, covered metal, tracheal bifurcation stent by flexible bronchoscopy resulted in immediate closure of the fistula with an uneventful recovery.

Topics: Alloys; Brachytherapy; Bronchoscopy; Carcinoma, Squamous Cell; Esophageal Neoplasms; Humans; Male; Middle Aged; Palliative Care; Stents; Tomography, X-Ray Computed; Tracheoesophageal Fistula

A metallic stent for tracheobronchial stenosis provides a possible solution for poststenting complications such as sputum retention. We describe our experience with a novel anatomy-conforming metal stent placement at the carina.. A windowed stent was designed to match the tracheobronchial anatomy. The lateral window was used as a passage from the trachea to the contralateral main bronchus.. Six windowed stents were placed in 6 patients (mean age, 52.3 years). Two patients received an additional short straight stent placed in the contralateral bronchus, forming an overall Y stent at the carina. All patients had immediate relief from respiratory distress, and no sputum retention or stent migration occurred during the subsequent treatment period. Follow-up data showed that 4 patients are still alive. One patient died 2 months after stent placement of postradiation hemoptysis, and another died of metastasis 14 months after stent placement.. This anatomy-conforming metal stent has several advantages and its application in carinal stenosis is both effective and safe.

Topics: Adult; Alloys; Bronchial Diseases; Bronchoscopy; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Constriction, Pathologic; Dyspnea; Equipment Design; Female; Humans; Lung Neoplasms; Male; Middle Aged; Palliative Care; Respiratory Insufficiency; Stents; Tomography, X-Ray Computed; Tracheal Neoplasms; Tracheal Stenosis

Topics: Adult; Alloys; Bronchial Diseases; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Constriction, Pathologic; Equipment Design; Female; Humans; Lung Neoplasms; Male; Middle Aged; Palliative Care; Stents; Tracheal Neoplasms; Tracheal Stenosis

To assess the clinical effectiveness of temporary metallic stent placement with concurrent radiation therapy in patients with esophageal carcinoma by comparing it with permanent stent placement with concurrent radiation therapy.. Covered retrievable expandable nitinol stents were placed in 47 patients with esophageal carcinoma 1 week before starting radiation therapy; the stents were electively removed 4 weeks after placement in 24 patients (group A), while not electively removed in the other 23 patients (group B). In cases of complications, the stents were also removed from patients in groups A and B. The dysphagia score, complications (severe pain, granulation tissue formation, stent migration, esophagorespiratory fistula, and hematemesis), tumor overgrowth/regrowth, reintervention rates, and dysphagia-progression-free and overall survival rates were compared in the two groups.. Stent placement or removal was technically successful and well tolerated in all patients. The dysphagia score was significantly improved in both groups after stent placement (P < .01). Each of the stent-related complications was less in group A than in group B but there was no significant difference. However, the total number of patients with one or more than one complications and who needed related reinterventions was significantly less in group A than in group B (P = .042 and .030, respectively). Tumor overgrowth/regrowth and the total number of patients who required related reinterventions was not significantly different (P = 1.00 and .517, respectively). Dysphagia-progression-free and overall survival rates were significantly longer in group A than in group B (P = .005 and .001, respectively).. Temporary placement of a covered retrievable expandable metallic stent with concurrent radiation therapy for patients with esophageal carcinoma is beneficial for reducing complications and related reinterventions and for increasing resultant survival rates compared with permanent esophageal stent placement.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Carcinoma, Squamous Cell; Case-Control Studies; Coated Materials, Biocompatible; Deglutition Disorders; Esophageal Neoplasms; Esophageal Stenosis; Female; Humans; Korea; Male; Middle Aged; Polyurethanes; Postoperative Complications; Prospective Studies; Retrospective Studies; Stents; Survival Analysis

Topics: Alloys; Carcinoma, Squamous Cell; Endoscopy; Esophageal Neoplasms; Esophageal Stenosis; Foreign-Body Migration; Humans; Palliative Care; Stents

To evaluate the long-term palliative effect of self-expanding nitinol esophageal stents in patients with malignant dysphagia.. One hundred patients with severe dysphagia secondary to malignant esophageal strictures were treated with self-expanding nitinol stents. The strictures were caused by squamous carcinoma (n = 43), adenocarcinoma (n = 28), anastomotic tumor recurrence (n = 14), and mediastinal tumor (n = 15).. One hundred six stents were successfully positioned in 100 patients. Attempts to insert a second, coaxial stent were unsuccessful in two patients; a second stent was placed incorrectly in another patient. Statistically significant (P < .001) reduction of dysphagia was noted after expansion of the stents. Complications consisted of incomplete expansion secondary to stent twisting (n = 4), stent migration (n = 4), tumor ingrowth (n = 17), tumor overgrowth (n = 3), food impaction (n = 5), fracture of stent wires (n = 2), benign strictures at stent edges (n = 2), tumor bleeding (n = 3), and esophagorespiratory fistula (n = 5). The primary patency rate was 75% (77 of 102 stents); the secondary patency rate was 94% (96 of 102 stents). The survival time (mean, 6.2 months; range, 0.1-47 months) varied with the diagnosis.. Placement of self-expanding nitinol stents is safe and has a good long-term palliative effect on dysphagia in patients with malignant esophageal strictures.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Alloys; Anastomosis, Surgical; Carcinoma, Squamous Cell; Deglutition Disorders; Equipment Design; Equipment Failure; Esophageal Fistula; Esophageal Neoplasms; Esophageal Stenosis; Evaluation Studies as Topic; Female; Follow-Up Studies; Food; Foreign-Body Migration; Hemorrhage; Humans; Longitudinal Studies; Male; Mediastinal Neoplasms; Middle Aged; Neoplasm Recurrence, Local; Palliative Care; Respiratory Tract Fistula; Stents; Surface Properties; Survival Rate

A 68-year-old man was admitted because of dyspnea. Nine months earlier, he had undergone radiotherapy for esophageal carcinoma. Chest CT scan obtained on admission showed a tumor shadow behind the tracheal carina. Bronchoscopy revealed that the lower trachea and bilateral main bronchi were compressed from the back and narrowed by the esophageal cancer. To maintain the airway, under fluoroscopic and guide-wire control, a self-expanding nitinol stent (SENS, Accuflex, Microvasive) was implanted in the lower trachea and left main bronchus. At the same time, other SENS was similarly implanted in the lower trachea and right main bronchus. During the implantation, the left nitinol stent was connected to the side of the right nitinol stent to form a T-shape. There was little sputum at the joint portion of the stents and the ventilation of both lungs remained adequate. Severe dyspnea markedly improved after placement of two nitinol stents. Knitted SENS is made of a nickel titanium alloy. SENS was formulated for use in the management of biliary obstruction. However, it is highly flexible and easy to implant. So, it is suitable for the treatment of airway obstruction. Although the implantation of SENS in extensive tracheobronchial stenosis has not previously been reported, it should be useful for prevention of airway obstruction.

Topics: Aged; Alloys; Bronchial Diseases; Carcinoma, Squamous Cell; Constriction, Pathologic; Esophageal Neoplasms; Humans; Male; Stents

Topics: Alloys; Carcinoma, Squamous Cell; Esophageal Neoplasms; Humans; Male; Middle Aged; Radiography; Silicones; Stents; Tracheoesophageal Fistula

To treat inoperable tracheal stenosis by using nitinol endotracheal stent and to solve some problems facing endotracheal stenting with other kinds of stents.. The stent was made of nitinol wire. It can be deformed to smaller size in iced water. With a self-made introducer, the stent was placed in the location of stenosis. After hot water was injected into the introducer, the stent resumed its original form and anchored there itself.. Altogether, 5 patients with severe tracheal stenosis received this treatment. Dyspnea was relieved immediately after implantation of stents in all patients. Long-term follow-up also showed satisfactory results.. Nitinol stent has some remarkable advantages as compared with other tracheal stents. It can be used as a new endoprosthesis in treating narrowed trachea.

Topics: Adult; Aged; Alloys; Carcinoma, Adenoid Cystic; Carcinoma, Squamous Cell; Female; Follow-Up Studies; Humans; Male; Middle Aged; Stents; Tracheal Neoplasms; Tracheal Stenosis

To evaluate the usefulness of self-expanding nitinol stents in the palliative treatment of malignant dysphagia.. Eighty self-expanding nitinol stents were placed in 59 patients (43 men, 16 women; mean age, 55 years; age range, 23-75 years) with inoperable malignant stenosis due to squamous cell carcinoma of the esophagus (n = 36), adenocarcinoma (n = 19), invasion of the esophagus due to carcinoma of the lung (n = 2), and recurrent anastomotic carcinoma (n = 2). Dysphagia was graded on a scale of 0 to 3. Follow-up esophagograms were obtained to evaluate stent patency.. Stent placement was successful in all patients. The severity of dysphagia decreased at least one grade in all but one patient. Tumor ingrowth and overgrowth were seen in 21 (36%) patients 2 days to 7 months after stent placement and caused recurrent dysphagia. These 21 patients underwent balloon dilation and additional stent placement. A mediastinal fistula was seen in three patients (5%), ulceration in four (7%), stent torsion in three (5%), and incomplete expansion of the stent in two (2%). Repeat intervention was necessary in 51% of the patients.. There is a substantial range of drawbacks and complications associated with the use of self-expanding nitinol stents for palliation of malignant esophageal strictures. A covering would be necessary to prevent tumor ingrowth.

Topics: Adenocarcinoma; Adult; Aged; Alloys; Carcinoma, Squamous Cell; Deglutition Disorders; Esophageal Neoplasms; Esophageal Stenosis; Esophagus; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Palliative Care; Radiography; Stents

Percutaneous endoscopic gastrostomy (PEG) is a safe method with a low complication rate for providing enteral nutrition. While the "pull" method is the standard technique for PEG placement, alternatively "push" methods were developed in order to minimize peristomal wound infections caused by micro-organisms from the oropharyngeal cavity. Intragastral fixation of the "push" type PEG tube has always been a problem. The MEMOSOND-PEG uses a heat activated nitinol memory spiral as an anchor-like intragastral fixation. So far, an intraabdominal dislocation and a perforation have been reported as severe complications of this type of PEG tube. Five years after insertion we observed the development of an abscess induced by ingrowth of a nitinol spiral into the stomach wall as a further fatal complication in a patient with a MEMOSOND-PEG. The memory metal spiral had pierced the stomach wall after partial destruction of the polyurethane covering. The nitinol spiral was endoscopically extracted in several fragments. Ten days after extraction however, the patient died of combined kidney and liver failure due to a sepsis with Staphylococcus.

Topics: Abdominal Abscess; Alloys; Carcinoma, Squamous Cell; Combined Modality Therapy; Enteral Nutrition; Equipment Failure; Fatal Outcome; Foreign Bodies; Gastrostomy; Humans; Male; Middle Aged; Mouth Neoplasms; Neoplasm Recurrence, Local; Prosthesis-Related Infections; Staphylococcal Infections; Stomach

The purpose of this study was to evaluate technical and clinical results of self-expanding esophageal stent implanted in patients with malignant esophageal strictures and clinically significant dysphagia. From June 1992 to September 1994, 27 patients with inoperable tumors of the esophagus or gastric cardiac were treated by placement of 37 self-expanding nitinol stents. Water-soluble contrast and endoscopy studies were performed after the procedure and during the follow-up period. Successful stenting of the stricture was achieved in 27 patients. The mean dysphagia grade dropped from 2.3 to 1 (SD +/- 0.54) immediately after the procedure. After the insertion of the stent, 16 patients died in a period of time ranging from 0 to 13 months (mean 5.6 months), whereas at the end of the study 11 patients were alive 4-15 months after the procedure (mean 8.3 months). No major complications were observed. The results of this study are encouraging because esophageal stent placement was technically easy and clinically effective.

Topics: Adenocarcinoma; Aged; Alloys; Carcinoma, Squamous Cell; Cardia; Catheterization; Contrast Media; Deglutition Disorders; Equipment Design; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Female; Fluoroscopy; Follow-Up Studies; Humans; Male; Palliative Care; Radiography, Interventional; Retrospective Studies; Solubility; Stents; Stomach Neoplasms; Survival Rate; Water

We report here on two cases of fractured nitinol stents in the esophagus. In case 1, the correctly inserted stent broke spontaneously shortly after insertion. In a second case, a nitinol stent broke after laser application due to tumor ingrowth with massive bleeding. In both cases, a second stent was implanted in order to reestablish food passage. The fracture of the stent in case 1 seemed to be caused by defective material, whilst in case 2 the stent broke because of thermal overstrain during laser application. The use of electrocoagulation or laser in the stent area should therefore be avoided; argon plasma coagulation may offer an effective alternative in treating tumor ingrowth. As there was a risk from piercing broken filaments with the second stent, covering a fracture using stents with tight walls or plastic tubes seems to be a more effective approach than the inserting an uncovered stent type.

Topics: Aged; Alloys; Carcinoma, Squamous Cell; Constriction, Pathologic; Esophageal Neoplasms; Fatal Outcome; Female; Humans; Stents

A 57-year-old man was admitted because of dysphagia. Two year earlier, endoscopic ND-YAG laser treatment had been performed for squamous cell carcinoma of the tracheal carina. The esophagus was compressed and narrowed by invasion of lung cancer. After ballooning, under endoscopic and fluoroscopic control, a self-expanding nitinol stent (SENS, Ultraflex, Microvasive) was implanted in the esophagus. Immediately after esophageal prosthesis implantation, severe dyspnea and stridor developed because of tumor strictures in the left main bronchus. Under fluoroscopic and guide-wire control, SENS (Accuflex, Microvasive) was implanted in the tracheobronchial tree. Dyspnea, dysphagia and stridor were markedly improved after placement of two nitinol stents. Highly flexible, knitted, self-expanding nitinol stent is made of a nickel titanium alloy. Although the implantation of SENS in tracheobronchial stenosis has not previously been reported, it should be useful for prevention of airway obstruction.

Topics: Alloys; Carcinoma, Squamous Cell; Esophageal Stenosis; Humans; Lung Neoplasms; Male; Middle Aged; Quality of Life; Stents; Tracheal Stenosis

Thirty patients with incurable malignant obstruction of the oesophagus and cardia were treated with self expanding oesophageal memory metal stents (Ultraflex) in a prospective study. The endoprostheses were successfully placed in all patients. Within one week after implantation dysphagia had improved in 25 of 30 patients (83%). Stent expansion was incomplete within one week after implantation in 12 of 30 patients (40%). After an average of two dilatation sessions eight of 12 stents had expanded completely. Five patients complained of retrosternal pain and three of them suffered from heartburn over several days despite acid inhibition. Major problems in the follow up period occurred in 10 of 30 patients (30%) and included late perforation (one) and tumour ingrowth/overgrowth (nine). All of these complications were treated endoscopically. Improvement of the dysphagia of the patients with tumour ingrowth/overgrowth lasted for about eight weeks (median; range: 2-38 weeks). Until November 1994 six of 30 patients were still alive with a survival time of 309 days (median; range: 103-368 days). It is concluded that oesophageal memory metal stents are easy to implant, prove effective in the palliation of malignant oesophageal obstructions, and have a low risk of severe complications. The only disadvantages are that incomplete initial stent expansion as well as tumour ingrowth/overgrowth occurred in nearly one third of the patients.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Alloys; Carcinoma; Carcinoma, Squamous Cell; Cardia; Esophageal Neoplasms; Esophageal Stenosis; Female; Follow-Up Studies; Humans; Male; Middle Aged; Palliative Care; Prospective Studies; Stents; Stomach Neoplasms

Nitinol stents were used in ten patients as palliative treatment for carcinoma of the esophagus and the cardia. Following insertion of the stent the severity of dysphagia decreased on average from 3.2 to 1.5 (on a scale from 0-4). Difficulties with stent opening and passage through the gut were found particularly in the region of metal sutures at esophago-jejunal anastomoses. One stent, which had been obstructed by mucosal folds, had to be removed and replaced. One stent which had been incorrectly placed was extended by introducing a second stent by a coaxial technique. During the period of observation, six patients died after an average of 4.6 months. The palliative effect of the stent lasted on average for eleven weeks. In two patients the tumour grew beyond the stent and in three there was tumour growth into the stent.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Alloys; Carcinoma, Squamous Cell; Cardia; Deglutition Disorders; Esophageal Neoplasms; Esophageal Stenosis; Female; Humans; Male; Middle Aged; Palliative Care; Radiography; Stents; Stomach Neoplasms; Time Factors