nitinol and Esophageal-Neoplasms

Esophageal cancer is a very deadly disease, killing more than 15,000 people in the United States annually. Almost 400,000 new cases happen in the worldwide every year. More than 50% esophageal cancer patients are diagnosed at an advanced stage when they need an esophageal stent to open the blocked esophagus for feeding and drinking. Esophageal stents have evolved in stages over the years. Current clinically used stents commonly include stainless steel or nitinol self-expandable metallic stent (SEMS) and self-expandable plastic stent (SEPS). There are many choices of different types of stents and sizes, with fierce competition among manufacturers. However, current stent technology, whether uncovered, partially covered, fully covered SEMS or SEPS, has their own advantages to solve the dysphagia, stricture, and fistula problems, but they also cause some clinical complications. The ideal stent remains elusive. New 3D printing technique may bring new promising potential to manufacturing personalized esophageal stents. Drug-eluting stents could be the new avenue to do more than just pry open a stricture or cover a defect in the esophageal lumen, a possibility of proving local anticancer therapy simultaneously. Additionally, the lack of esophageal cancer animal models also hinders the progress of stent development. This paper reviews these topics for a comprehensive understanding of this field. In a conclusion, the ultimate goal of the future esophageal stent would have multifunction to treat the underlying conditions and restore esophageal function to near normal.

Topics: Alloys; Animals; Constriction, Pathologic; Deglutition Disorders; Drug-Eluting Stents; Equipment Design; Esophageal Neoplasms; Esophageal Stenosis; Esophagus; Fistula; Humans; Models, Animal; Palliative Care; Plastics; Printing, Three-Dimensional; Stainless Steel; Stents

To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal obstructions.. A systematic review and meta-analysis was performed following the PRISMA process. PubMed (Medline), EMBASE (Excerpta Medical Database), AMED (Allied and Complementary medicine Database), Scopus and online content, were searched for studies reporting on the NiTi-S polyurethane-covered double oesophageal stent for the treatment of malignant dysphagia. Weighted pooled outcomes were synthesized with a random effects model to account for clinical heterogeneity. All studies reporting the outcome of palliative management of dysphagia due to histologically confirmed malignant oesophageal obstruction using double-layered covered nitinol stent were included. The level of statistical significance was set at α = 0.05.. Six clinical studies comprising 250 patients in total were identified. Pooled technical success of stent insertion was 97.2% (95%CI: 94.8%-98.9%; I (2) = 5.8%). Pooled complication rate was 27.6% (95%CI: 20.7%-35.2%; I (2) = 41.9%). Weighted improvement of dysphagia on a scale of 0-5 scoring system was -2.00 [95%CI: -2.29%-(-1.72%); I (2) = 87%]. Distal stent migration was documented in 10 out of the 250 cases examined. Pooled stent migration rate was 4.7% (95%CI: 2.5%-7.7%; I (2) = 0%). Finally, tumour overgrowth was reported in 34 out of the 250 cases with pooled rate of tumour overgrowth of 11.2% (95%CI: 3.7%-22.1%; I (2) = 82.2%). No funnel plot asymmetry to suggest publication bias (bias = 0.39, P = 0.78). In the sensitivity analysis all results were largely similar between the fixed and random effects models.. The double-layered nitinol stent provides immediate relief of malignant dysphagia with low rates of stent migration and tumour overgrowth.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Deglutition Disorders; Esophageal Neoplasms; Esophageal Stenosis; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Statistics as Topic; Stents; Treatment Outcome

Ultraflex esophageal stents have contributed to the tremendous success of self-expanding metal stents (SEMS) in the treatment of esophageal cancer because they are easy and safe to insert. With an eye to improving clinical outcome, the Ultraflex stent design has been in a state of constant evolution since its introduction. However, as with other SEMS, a high reintervention rate remains a challenging problem.

Topics: Alloys; Biocompatible Materials; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Humans; Palliative Care; Plastics; Pliability; Postoperative Complications; Prosthesis Design; Prosthesis Implantation; Stents

To evaluate the therapeutic effect of radiotherapy for esophageal cancer after expandable metallic stent placement.. Ten cases of advanced esophageal cancer were evaluated, 7 having complete obstruction and 3 with digestive-respiratory fistula. Ten nitinol stents were placed at the site of stenosis. Patients were treated with a total dose of 1 200 cGy divided into 3 fractions of 400 cGy 4-7 d after stents placement.. All the 10 stents were placed successfully at one time. After radiotherapy for advanced esophageal cancer, the survival period of the cases ranged from 14 to 22 mo, with a mean survival of 17 mo. No re-stenosis occurred among all the 10 cases.. Stent placement combined with radiotherapy for esophageal cancer is helpful to prolong patients' survival and reduce occurrence of re-stenosis.

Topics: Aged; Aged, 80 and over; Alloys; Coated Materials, Biocompatible; Esophageal Neoplasms; Esophageal Stenosis; Female; Humans; Male; Membranes, Artificial; Middle Aged; Silicones; Stents; Survival Analysis

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

Self-expanding metal stents are a promising alternative in the palliation of malignant esophageal obstruction, but the relative value of different stent types is not well established.. During a 3-year enrollment period in four different centers, 82 consecutive patients with malignant dysphagia without tumor recurrence after surgery or esophagorespiratory fistulas received either an uncovered Wallstent (44 patients) or a knitted nitinol stent (38 patients).. Age (median: 79 yr), sex (F:M = 33:67), dysphagia score (median: 3), Karnofsky score (median: 53), body mass index (median: 19), type of pretreatment, tumor stage, stricture length (median: 5.4 cm), and stricture location were comparable in both stent groups. After stent placement, median dysphagia score improved markedly in both groups by two points. Procedure-related mortality (16 vs 0%; p < 0.01), early complication rate (32 vs 8%; p < 0.01), and severe persistent pain after stent placement (23 vs 0%; p < 0.002) were higher in the Wallstent compared with the knitted nitinol stent group. In contrast, stent dysfunction (7 vs 32%; p < 0.005), reintervention rate (9 vs 34%; p < 0.005), and costs were lower in the Wallstent compared with the nitinol stent group.. In malignant esophageal obstruction, both stents markedly improved dysphagia. Uncovered Wallstents seem to cause more early severe complications than knitted nitinol stents. In contrast, stent dysfunction, reintervention rate, and costs appear to be higher in the nitinol stent group.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Body Mass Index; Costs and Cost Analysis; Deglutition Disorders; Equipment Design; Esophageal Neoplasms; Esophageal Stenosis; Female; Humans; Karnofsky Performance Status; Male; Middle Aged; Neoplasm Staging; Pain; Palliative Care; Retreatment; Stents; Surface Properties; Survival Rate

Tumor ingrowth through self-expanding metal stents presents a difficult problem for management. The techniques for treating tumor ingrowth have not yet been well described, and the optimal endoscopic approach is not clear. We have recently used photodynamic therapy (PDT) to treat tumor ingrowth through uncovered nitinol mesh stents.. Four patients (mean age 73) with obstructive adenocarcinomas of the distal esophagus had received self-expanding stents for palliation of their dysphagia. After stent placement, tumor ingrowth had caused progressive dysphagia in all of the patients; the dysphagia was graded on a scale from 0 (normal) to 4 (inability to swallow liquids). All of the patients received PDT treatment.. After PDT, excellent palliation of the dysphagia was seen in all of the patients, with a mean improvement in the dysphagia score of 2.25 and a mean dysphagia-free interval of 92 days. There were no major complications.. The use of PDT to treat tumor ingrowth through self-expanding metal esophageal stents is effective and safe.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Alloys; Deglutition Disorders; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Female; Foreign-Body Reaction; Hematoporphyrin Derivative; Humans; Male; Middle Aged; Palliative Care; Photochemotherapy; Photosensitizing Agents; Prognosis; Stents; Survival Rate

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: Adult; Aged; Aged, 80 and over; Alloys; Endoscopes; Endoscopy; Esophageal Neoplasms; Female; Gastric Outlet Obstruction; Humans; Male; Middle Aged; Palliative Care; Prognosis; Prospective Studies; Stents; Stomach Neoplasms

CASE DESCRIPTION A 10-year-old spayed female Rottweiler was referred for evaluation because of a 2-month history of regurgitation and weight loss, despite no apparent change in appetite. The dog had received antiemetic and antacid treatment, without improvement. CLINICAL FINDINGS Physical examination revealed a low body condition score (2/5), but other findings were unremarkable. Diffuse, global esophageal dilatation was noted on plain thoracic radiographs, and normal motility was confirmed through videofluoroscopic evaluation of swallowing. Transhepatic ultrasonographic and CT examination revealed a circumferential, intraparietal lesion in the distal portion of the esophagus causing distal esophageal or cardial subobstruction and no metastases. Incisional biopsy of the lesion was performed, and findings of histologic examination supported a diagnosis of esophageal leiomyoma. TREATMENT AND OUTCOME In view of numerous possible complications associated with esophageal surgery, the decision was made to palliatively treat the dog by transcardial placement of a self-expanding, covered, nitinol esophageal stent under endoscopic guidance. Two weeks after stent placement, radiography revealed complete migration of the stent into the gastric lumen. Gastrotomy was performed, and the stent was replaced and fixed in place. Twenty-four months after initial stent placement, the dog had a healthy body condition and remained free of previous clinical signs. CLINICAL RELEVANCE Diffuse benign muscular neoplasia should be considered as a differential diagnosis for acquired esophageal dilatation in adult and elderly dogs. In the dog of this report, transcardial stent placement resulted in resolution of the clinical signs, with no apparent adverse effect on digestive function. The described procedure could be beneficial for nonsurgical treatment of benign esophageal tumors in dogs.

Topics: Alloys; Animals; Diagnosis, Differential; Dog Diseases; Dogs; Esophageal Neoplasms; Esophagus; Female; Leiomyoma; Stents; Tomography, X-Ray Computed; Vomiting

To evaluate the long-term clinical outcomes and the negative predictors after the deployment of double-layered stents in malignant esophageal strictures.. This is a single-center study of patients who received a double-layered covered stent for the palliation of dysphagia due to malignant esophageal strictures in a 3-year period. 56 patients fulfilled the inclusion criteria. The study's primary end points were technical success, dysphagia improvement, stent migration, and complication rates; secondary end points were the stent's primary patency and overall survival. Cox regression analysis was used to adjust for confounding variables and to identify predictors of survival outcomes.. Technical success was 95%. Median dysphagia score improved significantly after stenting (p < 0.0001). Stent migration rate was 7.1% and occurred exclusively in the group of patients who received chemoradiotherapy (p < 0.01). The median stent patency was 87 days (range 5-444 days). Dysphagia reoccurred in 39.3% and was successfully managed with restenting in 98.2%. The median survival was 127 days (range 15-1480 days). Chemoradiotherapy and baseline histology did not influence survival outcomes. Survival was adversely affected by metastases (p = 0.005) and poor oral intake (p = 0.048). Patient survival was improved by repeat stenting in case of tissue overgrowth (p = 0.06).. The device is safe and effective for the treatment of patients with dysphagia due to esophageal cancer. Migration rate is zero for patients who do not receive chemoradiotherapy. Reintervention when required is a positive survival predictor.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Chemoradiotherapy; Deglutition Disorders; Esophageal Neoplasms; Female; Fluoroscopy; Foreign-Body Migration; Humans; Male; Middle Aged; Palliative Care; Postoperative Complications; Predictive Value of Tests; Prosthesis Design; Recurrence; Retreatment; Retrospective Studies; Risk Factors; Stents; Survival Rate; Treatment Outcome

Self-expandable esophageal stents are increasingly used for palliation or as an adjunct to chemoradiation for esophageal neoplasia. The optimal esophageal stent design and material to minimize dose perturbation with external beam radiation are unknown. We sought to quantify the deviation from intended radiation dose as a function of stent material and mesh density design.. A laboratory dosimetric film model was used to quantify perturbation of intended radiation dose among 16 different esophageal stents with varying material and stent mesh density design.. Radiation dose enhancement due to stent backscatter ranged from 0 % to 7.3 %, collectively representing a standard difference from the intended mean radiation dose of 1.9 (95 % confidence interval [CI] 1.5 - 2.2). This enhancement was negligible for polymer-based stents and approached 0 % for the biodegradable stents. In contrast, all metal alloy stents had significant radiation backscatter; this was largely determined by the density of mesh design and not by the type of alloy used.. Stent characteristics should be considered when selecting the optimal stent for treatment and palliation of malignant esophageal strictures, especially when adjuvant or neo-adjuvant radiotherapy is planned.

Topics: Alloys; Analysis of Variance; Chi-Square Distribution; Equipment Design; Esophageal Neoplasms; Esophageal Stenosis; Humans; Palliative Care; Polymers; Radiation Dosage; Radiometry; Radiotherapy Dosage; Stainless Steel; Stents; Surgical Mesh

The aim of this study was to evaluate the clinical effectiveness of covered Niti-S stent placement under multidetector CT and fluoroscopy guidance for the palliation of dysphagia in patients with cervical esophageal cancer. Under radiological imaging guidance using axial and sagittal CT scans, and fluoroscopy, Niti-S esophageal stents were placed in ten consecutive patients with complete obstruction caused by cervical esophageal cancer (9 men and 1 woman; age range = 54-79 years; mean age = 68.1 years) between February 2010 and December 2011. The procedure time and technical success rate were evaluated. Swallowing improvement was assessed by the following items: ability to eat and/or swallow (graded as follows: 3 = ability to eat normal diet, 2 = ability to eat semisolids, 1 = ability to swallow liquids, 0 = complete obstruction). Procedural and post-procedural complications were also evaluated. Survival (mean ± SD) was examined. The mean (±SD) procedure time was 40 ± 19 min (range = 21-69 min). Stent placement was technically successful in all patients; inadequate stent deployment did not occur in any case. Ability to eat and/or swallow was improved and scored 2.4 (score 3 in 5 cases, score 2 in 4 cases, score 1 in 1 case, and score 0 in no case) after stent placement. No major or post-procedural complications were encountered. The mean survival time was 131 ± 77 days (range = 31-259 days). Niti-S stents appeared to be a safe and effective device for the palliation of dysphagia caused by advanced cervical esophageal cancer. Multidetector CT and fluoroscopy image guidance helped the operators accurately place the stents in the cervical esophagus.

Topics: Aged; Alloys; Coated Materials, Biocompatible; Deglutition; Deglutition Disorders; Esophageal Neoplasms; Female; Fluoroscopy; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Palliative Care; Retrospective Studies; Stents

Fully covered esophageal self-expandable metallic stents (SEMS) often are used for palliation of malignant dysphagia. However, experience and data on these stents are still limited. The purpose of this multicenter study was to evaluate the efficacy and safety of fully covered nitinol SEMS in patients with malignant dysphagia.. 37 patients underwent placement of a SEMS during a 3 year period. Five patients underwent SEMS placement as a bridge to surgery: one for tracheoesophageal fistula in the setting of squamous cell carcinoma of the esophagus, one for perforation in setting of esophageal adenocarcinoma, 27 for unresectable esophageal cancer (16 adenocarcinoma, 11 squamous cell carcinoma), two for lung cancer, and one for breast-cancer-related esophageal strictures.. SEMS placement was successful in all 37 patients. Immediate complications after stent deployment included chest pain (n = 6), severe heartburn (n = 1), and upper gastrointestinal bleeding requiring SEMS revision (n = 1). Dysphagia scores improved significantly from 3.2 ± 0.4 before stent placement to 1.4 ± 1.0 at 1 month (P < 0.0001), 1.1 ± 1.2 (P < 0.0001) at 3 months, and 1.3 ± 1.4 (P = 0.0018) at 6 months. The stent was removed in 11 patients (30%) for the following indications: resolution of stricture (n = 3), stent malfunction (n = 5), and stent migration (n = 3). After stent removal, three patients were restented, three underwent dilation, and two underwent PEG placement. Mean survival for the 37 patients after stent placement was 146.3 ± 143.6 (range, 13-680) days.. Our study suggests that fully covered SEMS placement improve dysphagia scores in patients with malignant strictures, particularly in the unresectable population. Further technical improvements in design to minimize long-term malfunction and migration are required.

Topics: Aged; Alloys; Deglutition Disorders; Device Removal; Esophageal Neoplasms; Esophageal Stenosis; Female; Fluoroscopy; Foreign-Body Migration; Humans; Male; Middle Aged; Prosthesis Failure; Radiography, Interventional; Stents; Treatment Outcome

The purpose of this study was to evaluate the clinical effectiveness of polytetrafluoroethylene (PTFE)-covered retrievable expandable nitinol stents in patients with malignant esophageal strictures and to identify prognostic factors associated with clinical outcomes.. From 2001 to 2010, 320 PTFE-covered stents were placed in 270 patients. Technical and clinical success, complications, survival, and stent patency were measures of clinical effectiveness. The relationships among complications and age, sex, stricture location, stricture length, chemotherapy alone, chemoradiotherapy, and malignancy source were examined. Independent prognostic factors of overall survival and stent patency were identified.. Stent placement and removal were technically successful and tolerated without procedural complications, and 98% of patients achieved clinical success. The complication rate was 30%. Two removed stents exhibited covering membrane separation. Chemotherapy was associated with increased stent migration (p = 0.002). Stricture location and chemoradiotherapy were associated with esophagorespiratory fistula development (p = 0.033 and p < 0.001, respectively). Median and mean survival periods were 114 days (95% CI, 102-126 days) and 166 days (138-193 days). Chemotherapy and chemoradiotherapy were independent prognostic factors for survival (p = 0.050 and p = 0.032, respectively). The median and mean stent patency periods were 60 days (41-79 days) and 90 days (71-108 days). Chemoradiotherapy was the only independent prognostic factor for stent patency (p = 0.012).. The PTFE-covered stents were clinically effective. Membrane degradation was not evident, although 0.7% of the patients experienced covering membrane separation. Chemotherapy was associated with increased migration and prolonged survival. Chemoradiotherapy was associated with increased esophagorespiratory fistula formation and decreased stent patency.

Topics: Alloys; Coated Materials, Biocompatible; Combined Modality Therapy; Device Removal; Esophageal Neoplasms; Esophageal Stenosis; Female; Fluoroscopy; Foreign-Body Migration; Humans; Male; Middle Aged; Polytetrafluoroethylene; Prognosis; Proportional Hazards Models; Radiography, Interventional; Retrospective Studies; Risk Factors; Stents; Survival Rate; Treatment Outcome

We evaluated the effectiveness of a double-layered polytetrafluoroethylene (PTFE)-covered nitinol stent in the palliative treatment of malignant esophageal strictures. A double-layered PTFE-covered nitinol stent was designed to reduce the propensity to migration of conventional covered stent. The stent consists of an inner PTFE-covered stent and an outer uncovered nitinol stent tube. With fluoroscopic guidance, the stent was placed in 32 consecutive patients with malignant esophageal strictures. During the follow-up period, the technical and clinical success rates, complications, and cumulative patient survival and stent patency were evaluated. Stent placement was technically successful in all patients, and no procedural complications occurred. After stent placement, the symptoms of 30 patients (94%) showed improvement. During the mean follow-up of 103 days (range, 9-348 days), 11 (34%) of 32 patients developed recurrent symptoms due to tumor overgrowth in five patients (16%), tumor ingrowth owing to detachment of the covering material (PTFE) apart from the stent wire in 3 (9%), mucosal hyperplasia in 2 (6%), and stent migration in 1 (3%). Ten of these 11 patients were treated by means of placing a second covered stent. Thirty patients died, 29 as a result of disease progression and 1 from aspiration pneumonia. The median survival period was 92 days. The median period of primary stent patency was 190 days. The double-layered PTFE-covered nitinol stent seems to be effective for the palliative treatment of malignant esophageal strictures. We believe that the double-layer configuration of this stent can contribute to decreasing the stent's migration rate.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Coated Materials, Biocompatible; Constriction, Pathologic; Equipment Design; Esophageal Neoplasms; Esophageal Stenosis; Esophagus; Female; Follow-Up Studies; Humans; Male; Middle Aged; Polytetrafluoroethylene; Radiography; Radiology, Interventional; Recurrence; Stents; Survival Analysis; Treatment Outcome; Vascular Patency

To compare 2 different types of covered esophageal nitinol stents (Ultraflex and Choostent) in terms of efficacy, complications, and long-term outcome.. A retrospective review of a consecutive series of 65 patients who underwent endoscopic placement of an Ultraflex stent (n = 33) or a Choostent (n = 32) from June 2001 to October 2009 was conducted.. Stent placement was successful in all patients without hospital mortality. No significant differences in patient discomfort and complications were observed between the Ultraflex stent and Choostent groups. The median follow-up time was 6 mo (inter-quartile range 3-16 mo). Endoscopic reintervention was required in 9 patients (14%) because of stent migration or food obstruction. No significant difference in the rate of reintervention between the 2 groups was observed (P = 0.8). The mean dysphagia score 1 mo after stent placement was 1.9 +/- 0.3 for the Ultraflex stent and 2.1 +/- 0.4 for the Choostent (P = 0.6). At 1-mo follow-up endoscopy, the cover membrane of the stent appeared to be damaged more frequently in the Choostent group (P = 0.34). Removal of the Choostent was possible up to 8 wk without difficulty.. Ultraflex and Choostent proved to be equally reliable for palliation of dysphagia and leaks. Removal of the Choostent was easy and safe under mild sedation.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Deglutition Disorders; Device Removal; Esophageal Fistula; Esophageal Neoplasms; Esophageal Stenosis; Female; Humans; Male; Middle Aged; Palliative Care; Retrospective Studies; Stents; Treatment Outcome

Formation of granulation tissue and stricture at the stent's ends are well-known long-term complications of esophageal subtotally covered externally self-expandable metal stents (SEMS). Removal is associated with an increased risk of mucosal injury, severe bleeding, mediastinis, and consecutive stenosis. We report on a case of successful endoscopic removal of an esophageal SEMS 11 months after original placement to cover an iatrogenic esophageal perforation created during rigid esophagoscopy in a patient with cancer of unknown primary (CUP) syndrome. This case shows that safe SEMS late removal is achievable and at the same time illustrates the disadvantages of using SEMS for benign esophageal pathology. Particularly in cases of accidental esophageal injury during endoscopy, esophageal SEMS placement should be considered as a therapeutic option only if conventional surgery is contraindicated.

Topics: Aged; Alloys; Device Removal; Esophageal Neoplasms; Esophagoscopy; Humans; Male; Stents; Tomography, X-Ray Computed

To assess the efficacy and safety of covered retrievable nitinol stents in oesophageal cancer patients with airway involvement.. Under fluoroscopic guidance, covered retrievable nitinol airway stents were placed in 23 oesophageal cancer patients with airway stricture and/or oesophagorespiratory fistula (ERF) over a long period of 12 years. Six patients only had aspiration by ERF and three patients had both airway stricture and asymptomatic ERF. Technical aspects, dyspnoea improvement, and/or resolution of ERF symptoms, complications, reinterventions, and survival data were evaluated.. A total of 27 airway stents (14 tracheal, 11 bronchial, and two hinged) were placed successfully in 23 patients with airway stricture or ERF. Dyspnoea score decreased significantly after stent placement (p<0.001). ERF were sealed off in all nine patients. Complications included stent migration or expectoration (n=4), haemoptysis (n=2), sputum retention (n=7), and tumour overgrowth (n=1). All three migrated stents were easily removed. Twenty-one patients died, with the median survival period of 76 days (range 2-197 days).. Placement of covered retrievable expandable nitinol stents was safe and effective for the palliative treatment of airway strictures and/or ERF, with a reasonable range of complications, in patients with advanced oesophageal cancer.

Topics: Adult; Aged; Airway Obstruction; Alloys; Bronchi; Bronchography; Device Removal; Epidemiologic Methods; Esophageal Fistula; Esophageal Neoplasms; Female; Fluoroscopy; Foreign-Body Migration; Humans; Male; Middle Aged; Neoplasm Invasiveness; Palliative Care; Radiography, Interventional; Respiratory Tract Fistula; Stents; Tracheal Stenosis; Treatment Outcome

Topics: Alloys; Esophageal Neoplasms; Esophageal Stenosis; History, 20th Century; History, 21st Century; Humans; Palliative Care; Patient Selection; Prosthesis Design; Prosthesis Implantation; Stents; 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

Dysphagia is the most common disabling symptom in patients with inoperable esophagogastric carcinoma. Self-expanding metal stents are highly effective in the palliation of these patients.. In 35 patients with inoperable carcinoma of the esophagus or the stomach, with recurrent tumor or complications after transhiatal esophagectomy or gastrectomy or with esophageal stenosis caused by pulmonary cancer, a self-expanding nitinol stent was placed to reduce dysphagia. Dysphagia and WHO performance status were assessed, before and after stent placement.. In 35 patients, 39 stents were placed without technical problems. Dysphagia improved significantly. The WHO performance status remained stable. Mean survival of all patients was 11 weeks. Major complications occurred in 3 patients. One patient died of massive tumor bleeding. Minor complications such as stent migration or retrosternal pain occurred in 5 patients. In 2 patients the migrated stent could successfully be placed in the correct position after giving ice-cooled water through the endoscope. Four patients had esophagorespiratory fistulas which were all initially successfully occluded.. This nitinol stent is highly effective for improving dysphagia in patients with malignant esophagogastric obstruction. We observed no procedure-related complications. Bleeding was the principal major complication. The early intake of cold beverages resulted in stent migration. Recurrent dysphagia due to overgrowth by tumor or nonmalignant tissue remains a problem. Technical improvements are desirable to reduce the overgrowth by nonmalignant tissue.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Deglutition Disorders; Esophageal Neoplasms; Esophageal Stenosis; Esophagectomy; Female; Gastrectomy; Humans; Lung Neoplasms; Male; Middle Aged; Palliative Care; Prosthesis Implantation; Statistics, Nonparametric; Stents; Stomach Neoplasms; Time Factors; World Health Organization

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

The aim of this retrospective study was to present and compare the results of using two different types of esophageal self-expanding stents (uncovered and covered) for palliative treatment of patients with inoperable malignant stenosis of the esophagus and cardia. Over a period of 8 years, 152 patients underwent fluoroscopically guided insertion of metal esophageal stents. We inserted uncovered esophageal nitinol Strecker stents in 54 patients (group I) and covered esophageal Ultraflex stents in the remaining 98 patients (group II). The stent insertion procedure was successively performed in all patients. Closure of esophageal fistula by covered stents was achieved in 8/8 patients. Mean dysphagia score was significantly decreased in both patient groups at 4 weeks follow-up: from 2.73 before stent insertion to 0.15 in group I, and from 2.67 to 0.05 in group II (on 0-4 scale). Eighty-eight per cent of patients with covered stents and 54% with uncovered type were free of symptoms during follow-up. Complications occurring during follow-up and their comparative frequency in the two groups of patients were as follows (group I: group II%): stent migration (0:10%); tumor or granulation tissue ingrowth (100:53%); overgrowth at the ends of stents (17:30%); restenosis causing recurrent dysphagia (37:8%); and appearance of esophageal fistulas (8:6%). In conclusion, fluoroscopically guided insertion of self-expandable esophageal stents is a safe and comfortable method of palliation for patients suffering with malignant dysphagia. In selection of a stent, covered types should be given priority for prevention of restenosis.

Topics: Aged; Alloys; Cardia; Deglutition Disorders; Equipment Design; Equipment Failure; Esophageal Fistula; Esophageal Neoplasms; Esophageal Stenosis; Female; Fluoroscopy; Follow-Up Studies; Granulation Tissue; Humans; Male; Middle Aged; Palliative Care; Radiography, Interventional; Recurrence; Retrospective Studies; Stents; Surface Properties; Surgical Mesh

The use of self-expanding metallic stents (SEMS) as esophageal endoprosthesis represents an advancement in the palliation of dysphagia from unresectable esophageal carcinoma. However, the problem of stent migration persists. Although most migrated stents have a benign outcome, complications do occur. Rare reports of intestinal obstruction have been confined to the stiff plastic and stainless-steel stents. We report the first case of intestinal obstruction secondary to the pliable Nitinol SEMS (Ultraflex) migration.

Topics: Adenocarcinoma; Aged; Alloys; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Deglutition Disorders; Device Removal; Epirubicin; Equipment Design; Esophageal Neoplasms; Fluorouracil; Foreign-Body Migration; Humans; Ileal Diseases; Intestinal Obstruction; Laparotomy; Liver Neoplasms; Male; Postoperative Complications; Stents

A flexible nitinol stent was inserted to treat malignant stricture of the esophagus in 28 patients. Stenting was successful in all 28 patients, leading to an improved oral intake that was maintained for >80% of the survival period in 26 patients. Patients with tumors arising in the esophagus (n=24) were divided into two groups to compare complications and prognosis: patients who underwent stenting only (n=10); and patients who underwent stenting after radiochemotherapy (n=14). Fatal complications associated with stenting were seen in four patients (28.6%) who underwent stenting after radiochemotherapy and in one patient (10.0%) who underwent stenting only. Although survival was significantly longer for patients who underwent prior radiochemotherapy than for patients who did not, the incidence of fatal complications tended to be higher. No significant differences in background factors other than radiochemotherapy before stenting were observed between patients with fatal and non-fatal complications. Stenting was shown to represent a useful treatment for malignant stricture of the esophagus, as oral intake improved and was maintained for a long period of time in most patients. However, incidence of fatal complications was high among patients who underwent radiochemotherapy, and caution must be exercised due to the difficulty in predicting fatal complications.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Carcinoma; Deglutition Disorders; Esophageal Neoplasms; Esophagoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Stents; Survival Rate; Treatment Outcome

Topics: Adenocarcinoma; Aged; Alloys; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Fatal Outcome; Humans; Intestinal Obstruction; Laparotomy; Male; Palliative Care; Pneumonia, Aspiration; Prosthesis Failure; Radiography, Abdominal; Stents

To evaluate the safety and clinical effectiveness of a covered retrievable expandable nitinol stent for the treatment of malignant tracheobronchial stricture and/or esophagorespiratory fistula (ERF).. With fluoroscopic guidance, stents were placed in 35 symptomatic patients with malignant tracheobronchial stricture and/or ERF in most cases caused by lung or esophageal cancer. The site of stricture was most commonly at the trachea or left main bronchus. If there were complications, the stent was removed with a retrieval set. Nine patients had combined symptomatic ERF.. A total of 47 tracheobronchial stents were placed and were technically successful and well-tolerated in all patients. Improvement of dyspnea was achieved in 92% of the patients (24 of 26 patients). Associated ERF in nine patients was effectively treated with tracheobronchial stent placement with or without esophageal stent placement. Stent migration, tumor overgrowth, symptomatic sputum retention, and hemoptysis occurred in 17% (6/35), 6% (2/35), 20% (7/35), and 17% (6/35) of patients, respectively. There were no documented cases of tumor ingrowth. Stent removal was performed easily in five patients when stent migration (n = 2), severe pain (n = 1), tumor overgrowth (n = 1), or persistent gastrobronchial fistula (n = 1) developed. All patients died 2 days to 26 weeks (mean, 9.62 weeks) after stent placement because of disease progression (n = 18), pneumonia (n = 9), hemoptysis (n = 5), or unknown cause (n = 3).. Use of a covered retrievable expandable nitinol stent is a safe and effective method for relieving dyspnea. This procedure contributed to improved quality of life for patients with malignant tracheobronchial stricture and/or ERF. Stent retrievability was useful in resolving stent-related complications.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Bronchial Diseases; Constriction, Pathologic; Dyspnea; Esophageal Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Palliative Care; Radiography, Interventional; Stents; Tracheal Stenosis; Tracheoesophageal Fistula; Treatment Outcome

Two types of self-expanding metal stents to palliate dysphagia in patients with unresectable malignant oesophageal strictures have been compared.. From February 1996 to October 2000, 50 metal stents (23 covered Ultraflex and 27 Esophacoil) were placed in 50 patients (40 males, mean age: 67+/-12 years, range: 33-100, mean dysphagia score: 3.18+/-0.66) with unresectable malignant oesophageal strictures. Patients were followed until death. A retrospective review has been made of a prospectively collected database.. The two groups were comparable as far as concerns degree of dysphagia, location and stricture length. Stent placement was successful in all cases. Covered Ultraflex stent was placed in 2 patients with oesophagobronchial fistula. No procedure-related deaths were seen. Early severe complications occurred in 2 patients (perforation in 1 and tumour bleeding in 1, in the Esophacoil group). Nine patients and 1 patient complained of pain following Esophacoil and Ultraflex stent placement, respectively. Late complications were asymptomatic rupture of distal Esophacoil rings in 2 patients, symptomatic Ultraflex stent migration in 2 and tumour overgrowth in 3 (Esophacoil 1, Ultraflex 2). Mean dysphagia score at 4 weeks after stent placement was 1.9+/-0.77. Mean survival was 177+/-109 days (range: 35-603 days). There were no significant differences in technical success, dysphagia palliation, complications (except chest pain) and survival using the two types of stent.. Self-expanding metal stents are safe with high technical success and achieve satisfactory long-term palliation for dysphagia. The covered Ultraflex and Esophacoil stents are equally effective.

Topics: Aged; Alloys; Deglutition Disorders; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Female; Humans; Male; Palliative Care; Retrospective Studies; Stents

The authors report their experience with three types of retrievable covered nitinol stents in patients with malignant esophageal strictures.. Three types of retrievable covered nitinol stents were designed. Type A stents were placed in 45 patients, type B stents were placed in 29 patients, and type C stents were placed in 34 patients. The stents were removed with use of a stent retrieval set under fluoroscopic guidance when the stents caused complications. Stent patency, symptom relief, survival rate, and complications were analyzed relative to stent type and radiation therapy.. The timing of radiation and the stent type have significant effects on occurrence of complications such as stent migration and fistula formation (P =.002 and P = 0.029, respectively). Complications were significantly more frequent in patients with the type B stent than those with type A or type C stents (P =.008). Patients who underwent radiation therapy before stent placement or who underwent no radiation therapy experienced substantially less complications than those who underwent radiation therapy after stent placement (P =.005 and P <.001, respectively). The survival period was significantly longer in patients who underwent radiation therapy after stent placement than in the other groups (P =.034). Stents were removed from 15 patients (14%) 2 days to 16 weeks (mean, 4 weeks) after stent placement as a result of severe pain (n = 7), stent migration (n = 6), or stent deformity (n = 2). Stent removal was well tolerated in all patients.. Use of retrievable covered nitinol stents seems to be a safe and effective method of treatment in patients with malignant esophageal strictures. However, removal of the stents was needed in 14% of the patients because of complications. Patients who underwent radiation therapy after stent placement and those with the type B stent experienced more complications than other patients.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Equipment Design; Esophageal Neoplasms; Esophageal Stenosis; Female; Humans; Male; Middle Aged; Palliative Care; Regression Analysis; Stents; Survival Analysis

Topics: Adenocarcinoma; Aged; Alloys; Deglutition Disorders; Equipment Failure Analysis; Esophageal Neoplasms; Esophageal Stenosis; Fatal Outcome; Humans; Male; Palliative Care; Stents; Ventricular Fibrillation

Expanding metal oesophageal stents are being used more commonly to palliate patients with inoperable oesophageal carcinoma. Many reports have so far documented their clinical effectiveness, however, their high acquisition cost has caused on-going concern when compared with the cost of conventional therapies. We reviewed 64 consecutive patients with inoperable oesophageal carcinoma, half of whom had received our conventional method of palliation using a variety of techniques including, BICAP diathermy, alcohol injection and Atkinson tube insertion. The other half (32 patients) were treated with expandable metal stents -- Gianturco Z stents (Cook UK Ltd) and uncovered Ultraflex stents (Microvasive, Boston Scientific). The physical amount of resources consumed were identified and measured (number of diagnostic and support procedures, days as in patients, number of day cases or outpatient attending) and an average NHS cost was applied to this resource use. All costs were summated over the period of palliation from the date of the first intervention with palliative intent until death. Although the patients in this study were not randomized, the two groups were matched to ensure comparability in clinical manifestation (uncomplicated biopsy proven oesophageal carcinoma) and the average age of patients from each group. A difference was identified between the length of survival in both patient groups and the analysis was corrected for this by estimating a cost per day of palliative support. Patients palliated with metal stents underwent fewer procedures and spent fewer days in hospital during the time period from presentation until death even when corrected for differences in survival. Patient outcome (effectiveness of palliation) was measured by recording mean dysphagia scores which were recorded before and after palliation. Metal stents were found to lead to a significantly higher improvement in dysphagia in comparison to conventional therapy. In addition, the mortality related to metal oesophageal stents was lower than Atkinson tube insertion. The average cost of palliation was much lower in the metal stent group (mean = pound sterling 2817) compared with the cost in those palliated conventionally (mean = pound sterling 4566). However, once this was corrected for survival the difference in the cost of palliation on a per diem basis was reduced (metal stents = pound sterling 60 per day, conventional group = pound sterling 72 per day). The results of our study in

Topics: Adult; Aged; Aged, 80 and over; Alloys; Cost-Benefit Analysis; Deglutition Disorders; Equipment Design; Esophageal Neoplasms; Health Care Costs; Humans; Length of Stay; Middle Aged; Palliative Care; Stents; Survival Rate

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

The purpose of this study was to determine the efficacy of the uncovered coil stents in patients with malignant dysphagia. Coiled spring-shaped uncovered self-expanding metallic Esophacoil stents (Instent, Eden Prairie, Minnesota) were placed in 11 patients (9 men and 2 women; age range 38-77 years, mean age 60.5 years) with malignant esophageal strictures and dysphagia, under fluoroscopic guidance. Dysphagia was graded on a scale of 0 to 4 (0 = no dysphagia; 1 = dysphagia to normal solids; 2 = dysphagia to soft solids; 3 = dysphagia to solids and liquids; 4 = complete dysphagia, inability to swallow saliva). Two patients had received radiation therapy, 4 had had chemotherapy, and 5 had had a combination of both radiation and chemotherapy before stent palliation. Control clinical examinations and endoscopic or barium swallow studies were performed every 4 weeks until the patient died. The stents were well tolerated by all patients and were effective in 9 of 11 patients with malignant dysphagia. Complications of the procedure included incomplete opening of the stent in 1 case, migration in 1 case, transient pain in 8 cases, reflux in 3 cases and minor gastrointestinal bleeding in 2 cases. Stent migration in 1 case resulted in surgical intervention and incomplete opening of the stent allowed only partial improvement of dysphagia in 1 case. The quality of life significantly improved in all other patients. Mean survival time of the patients was 73 days (range 34-125 days) and no significant tumor ingrowth was detected during the follow-up period. Insertion of an Esophacoil has a good palliative effect on dysphagia in patients with malignant esophageal strictures with few complications. Although the stent is uncovered, tumor ingrowth and overgrowth were not observed in our study, possibly because of previous treatments.

Topics: Adult; Aged; Alloys; Deglutition Disorders; Esophageal Neoplasms; Esophageal Stenosis; Female; Humans; Male; Middle Aged; Palliative Care; Radiography; Stents; Treatment Failure; Treatment Outcome

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

Topics: Adenocarcinoma; Alloys; Endoscopes; Equipment Failure; Esophageal Neoplasms; Esophagoscopes; Esophagoscopy; Fatal Outcome; Humans; Male; Middle Aged; Palliative Care; Stents

Topics: Alloys; Catheterization; Deglutition Disorders; Equipment Design; Esophageal Neoplasms; Esophagoscopy; Esophagus; Humans; Palliative Care; Plastics; Retreatment; Stents

Silicone and metal stents are available for the treatment of malignant bronchial stenoses. This project sought to compare the self-expanding nitinol Accuflex stent (Boston Scientific Corp; Watertown, Mass) with the passively expandable tantalum Strecker stent (Boston Scientific Corp; Watertown, Mass), both implanted by flexible bronchoscopy under local anesthesia and sedation. In 51 patients with malignant bronchial stenosis, 14 nitinol and 51 tantalum stents were used and stenoses of 75 to 100% were treated. The intervention was successful in all but one patient; a mean patency of 93% was achieved. In the follow-up period, the probability of survival was significantly lower in patients with total bronchus occlusion than in patients with stenotic alterations (44 vs 109 days; p<0.05). In 10 patients, lung function analysis after stent implantation revealed a significant increase in PaO2 (65 vs 71 mm Hg; p<0.01), inspiratory vital capacity (2.5 vs 2.7 L; p<0.05), and FEV1 (1.8 vs 2.0 L; p<0.05). Mucus retention was the main (39%) adverse factor in the early phase after stent implantation, whereas tumor penetration became the most frequent problem (67%) in the later phase. Recanalizing interventions were necessary in 18% of the cases in which tumor penetration occurred. Stent distortion occurred in 12 patients with Strecker and in none with Accuflex stents. In comparison to the Strecker stent, the self-expanding Accuflex stent is preferable owing to its excellent flexibility and faster delivery system. Both types of stents could be sufficiently deployed within the lesion and allowed for highly precise positioning. Furthermore, no general anesthesia was required. The fiberbronchoscopic mode of implantation under sedation is very efficient even for tumor patients with severe impairment of their physical and respiratory condition.

Topics: Alloys; Anesthesia, Local; Bronchial Diseases; Bronchoscopes; Bronchoscopy; Constriction, Pathologic; Equipment Design; Esophageal Neoplasms; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Respiratory Function Tests; Stents; Survival Rate; Tantalum; Time Factors

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

The endoscopic methods of palliative treatment in malignant esophageal stenoses caused by neoplasm which have been performed so far unfortunately do not provide permanently satisfying results. The implantation of self-expanding stents with the purpose of removing malignant esophageal obstructions has recently become the most acceptable method of treatment. By using that method it is possible to reduce or even completely remove difficulties in swallowing. In that way a significant improvement in life quality of patients with inoperable esophageal cancer is possible. The various types of metal endoprostheses used for the palliative treatment of esophageal malignant stenoses are described in this paper. Here is also presented a case of nitinol stent implantation in a 50 year old woman suffering from esophageal cancer. This type of therapeutic treatment has been applied in Croatia for first time.

Topics: Alloys; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Female; Humans; Middle Aged; Palliative Care; Stents

The purpose of our study was to evaluate the effectiveness of nitinol stents for palliation of dysphagia due obstructing esophageal cancer, safety of stent placement, and long-term results.. Self-expanding uncoated nitinol stents were inserted either radiologically (14 patients) or endoscopically (12 patients) on an outpatient basis in 26 consecutive patients with dysphagia grade 3 or 4 caused by incurable malignant obstructions in the middle or distal third of the esophagus (n = 22) or at esophagojejunal anastomoses (n = 4). No esophagotracheal fistulas were seen in any patient. In 22 patients prior treatments had failed. Following insertion, the stent lumen was dilated to the maximum diameter. Finally, esophagography or esophagoscopy was done to confirm the position of the stent and patency of the esophageal lumen. Twenty-four hours after the procedure, esophageal function was investigated by a barium swallow. Patients were encouraged to ingest solid food thereafter. Improvement in dysphagia was evaluated 1 week after stent placement and during monthly interviews. Complications were defined as major (aspiration, bleeding, stent misplacement or dislocation, perforation) or minor (reflux esophagitis, chest pain, pharyngeal discomfort). Tumor ingrowth or overgrowth was considered a treatment failure. Twenty-three patients (88%) were followed until death: three patients (12%) were followed for a mean of 14 months.. Exact positioning of the stent and dilation to its maximum diameter were technically feasible in all patients. No stents were placed in the stomach. Patency of the esophageal lumen was successfully restored in 25 patients. In one patient a broken strut of the stent after dilation caused a partial obstruction, which was detected endoscopically. Two patients had recurrent dysphagia due to tumor ingrowth or overgrowth, one after 1 month and the other after 3 months. In these patients an additional overlapping stent was successfully placed. No procedure-related mortalities or major complications occurred. The mean dysphagia grade of 3.5 was improved to a mean grade of 0.6 after stent placement. All patients could take liquids within the first 24 hr. Fifteen patients improved to dysphagia grade 0, seven patients to grade 1, and four patients to grade 2 within 1 week after the procedure. Twenty-three patients (88%) died during the follow-up period (mean survival, 5 months) as a result of their disease. Latest evaluation of the mean dysphagia grade was 0.7. Three patients (12%) are still alive (mean survival, 14 months) with a dysphagia grade 1 in one patient and grade 0 in two.. Implantation of nitinol stents proved to be an effective and safe method of palliating severe dysphagia in patients with obstructing esophageal cancer. The improvement in dysphagia was impressive and long lasting. Placement of the stents was feasible without major procedure-related complications.

Topics: Aged; Aged, 80 and over; Alloys; Deglutition Disorders; Esophageal Neoplasms; Esophagoscopy; Esophagus; Female; Humans; Male; Middle Aged; Palliative Care; Radiography, Interventional; Recurrence; Stents

Topics: Adenocarcinoma; Alloys; Equipment Design; Esophageal Neoplasms; Esophageal Stenosis; Female; Humans; Male; Middle Aged; Palliative Care; Stents

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

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

Metal mesh stents are a new way in the treatment of malignant stenoses. Between 11/91 and 12/93 in 79 patients with malignant stenoses of the esophagus and the esophago-gastric junction 96 highly elastic, knitted, self-expanding nitinol stents (Ultraflex, Boston Scientific) were implanted. Most of the tumors being problematic, preoperated or preradiated, in 78 of 96 implantations endoscopic pretreatment (Laser, Argon Plasma Coagulation (APC), dilatation)--mostly in the same session--was necessary. Follow up time was 21 (2-108) weeks. In this pilot study 3.5 (1-27) controlendoscopies with 2.5 (1-10) endoscopic interventions were performed. 90 of 96 implantations were primarily successful and led to a functional success in 73 of 79 patients. The ability to swallow improved significantly, the score of dysphagia improved from 3.5 to 1.0 (p < 0.001). There were no relevant complications and no stent-related mortality. All stents could be kept patent during the follow up period using the new developed Argon-plasma-coagulation (APC) to treat the ingrowth of granulation tissue or tumor, which was observed during follow up in 72 of 93 implantations. Tumor ingrowth represents the main problem of the method and demands endoscopic posttreatment (APC) in cases with relevant re-obstruction. Impairment of the stent lumen by tumor ingrowth (granulation tissue plays no role) would have been observed in about 60% of the patients without such a treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Aged, 80 and over; Alloys; Deglutition Disorders; Elasticity; Electrocoagulation; Equipment Design; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopes; Female; Follow-Up Studies; Humans; Male; Middle Aged; Palliative Care; Pilot Projects; Stents; Surface Properties

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

In recent years the implantation of self-expanding metal-stents has been recommended as a palliative kind of therapy for dysphagia caused by esophageal carcinoma. The metal-stent has a high flexibility, so that it can fit according to the preformed angel of the esophagocardial transition and does not cause a feeling of pressure when placed in the cervical position. From July 1992 to February 1995 in the surgical department of the University of Bonn 21 patients have got a self-expanding Nitinol stent. No dislocation, bleeding or perforation occurred. The dysphagia improved in all patients. The lethality rate was 9.5%, the mean survival rate 4,6 month. The growth of the tumor through the mesh of the stent was a problem which occurred from the tenth week onwards after implantation. Even when the self-expanding metal-stent does not solve all problems, it enlarges the spectrum of palliative kinds of therapy.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Female; Humans; Male; Middle Aged; Palliative Care; Prosthesis Design; Prosthesis Failure; Stents

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

Self-expanding metal stents have been recently used for the treatment of neoplastic esophageal stenoses. In our series, nitinol Strecker stents were implanted in ten patients with malignant esophageal intrinsic or extrinsic strictures, as a definitive palliation. Thirteen stents in all were used: two stents were positioned in three patients to recanalize the esophagus. The prostheses could always be inserted in the treated patients and in all of them swallowing was markedly improved. No major early complications were observed after stent insertion. All the stents but one were patent until the patient's death. Two patients are alive and bearing well-functioning stents. Self-expanding metal stents are to be preferred to plastic endoscopic tubes because their caliber is smaller at the time of insertion and they do not require general anesthesia, as endoscopic tubes sometimes require. Moreover, their complication rate is lower for both early and late complications. Tumor ingrowth through the stent mesh with stent occlusion is the major pitfall of these prostheses, together with the impossibility to use them when esophageal fistulas are present: these limitations will be soon overcome when silicone-coated expandable stents are on the market.

Topics: Aged; Aged, 80 and over; Alloys; Deglutition Disorders; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Esophagus; Female; Humans; Male; Middle Aged; Radiography, Interventional; Stents

A self-expanding esophageal nitinol stent was implanted under fluoroscopic guidance in 40 patients with malignant esophageal strictures and clinically significant dysphagia. The strictures were caused by squamous cell carcinoma (n = 14), adenocarcinoma (n = 12), recurrent anastomotic carcinoma (n = 8), and mediastinal tumors (n = 6). Eight stents were balloon dilated to maximum diameter immediately after insertion. Sixteen stents self-expanded to maximum diameter within 24 hours, and the other stents expanded to maximum diameter during further observation. There were no serious stent-related complications, and the dysphagia was reduced considerably in all patients immediately after stent insertion. Persistent tumor bleeding occurred in two patients, and ingrowth of tumor into the stent was seen in eight patients. Two stents occluded due to tumor ingrowth but were successfully recanalized with endoscopic laser coagulation. At the end of the study, 28 patients were dead with a mean survival of 2.9 months (range, 0.1-7.0 months), and 12 patients were alive with a mean follow-up of 8.8 months (range, 4.0-15.0 months).

Topics: Adult; Aged; Aged, 80 and over; Alloys; Esophageal Neoplasms; Esophageal Stenosis; Female; Humans; Male; Mediastinal Neoplasms; Middle Aged; Palliative Care; Radiography, Interventional; Stents

Nine patients (mean age 64, range 51-83 years), with dysphagia due to incurable malignant obstruction of the esophagus were treated by the introduction of 10 self-expanding metal endoprostheses (Nitinol stents). All cases were technically and functionally successful. In one patient the stent did not expand completely; it had to be removed and a second introduced. There were no other complications from the stent implantation. During the period of observation of 136 +/- 86 days one stent (11%) was reobstructed by tumor growing into the stent. Two patients died after 60 and 119 days, both with open stents. Early experience with the Nitinol stent indicates that good palliation of malignant dysphagia can be achieved with a much lower complication rate than results from tube implantation. The design and application system of the stent is capable of further improvement.

Topics: Aged; Alloys; Deglutition Disorders; Equipment Design; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Esophagus; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nickel; Pilot Projects; Radiography; Recurrence; Stents; Titanium

The authors present the case of an 81-year-old male patient with cardia adenocarcinoma. The patient underwent a surgical resection. Due to local recurrence Gianturco prosthesis implantation was performed. After 5 months of unimpeded swallowing, the patient gradually lost his ability to swallow. This was caused by tumor overgrowth. The serious condition was managed by nitinol (Ultraflex) metallic prosthesis. This reticular, compressed stent is a nickel-titanium based alloy. After implantation, as a result of the body temperature it assumes its original shape. After the twofold prosthesis implantation the patient had no complaints. The authors found the case worthy of presentation because of the new method and the originality of the new design.

Topics: Aged; Aged, 80 and over; Alloys; Esophageal Neoplasms; Esophageal Stenosis; Humans; Male; Neoplasm Recurrence, Local; Prostheses and Implants; Prosthesis Design; Radiography; Stents

Topics: Alloys; Esophageal Neoplasms; Humans; Stents

Topics: Aged; Alloys; Constriction, Pathologic; Dilatation; Esophageal Neoplasms; Esophageal Stenosis; Humans; Intestinal Obstruction; Male; Rectal Diseases; Rectal Neoplasms