nitinol and Stomach-Neoplasms

A high incidence of migration with covered metal stents has been reported in malignant gastric outlet obstruction (GOO). A newly modified, partially covered, triple-layer nitinol stent was developed that has a longer uncovered portion (5-15 mm) to prevent stent migration.. To estimate the efficacy and safety of the modified covered, triple-layer metal stent.. Multicenter, prospective cohort study.. Three tertiary referral centers.. Fifty consecutive patients (26 with pancreatic carcinoma, 14 with gastric carcinoma, 9 with cholangiocarcinoma, 1 with a metastatic node) who presented with symptomatic unresectable malignant GOO between April 2007 and March 2010.. Endoscopic placement of the modified covered, triple-layer metal stent.. The primary endpoint was to improve the GOO scoring system (GOOSS) score. Secondary endpoints were success rate, patency, and complications.. The median GOOSS score improved significantly (P < .0001) after stenting (from 0 to 3). The technical and clinical success rates were 100% and 90%, respectively. Stent occlusion by tumor overgrowth or ingrowth at the uncovered portion developed in 5 patients (10%). Asymptomatic stent migration occurred in 3 patients (6%) receiving chemotherapy at 95, 230, and 553 days after stent placement, but these patients tolerated solid food 68, 260, and 142 days after stent migration, respectively. Other complications occurred in 1 patient with insufficient expansion, cholangitis, and pancreatitis. No procedure-related deaths occurred.. A single-arm study in tertiary-care centers.. The modified covered, triple-layer metal stent was effective and safe for managing malignant GOO and can prevent tumor ingrowth and stent migration. (. UMIN000004566.).

Topics: Aged; Alloys; Bile Duct Neoplasms; Carcinoma; Cholangiocarcinoma; Female; Gastric Outlet Obstruction; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Pancreatic Neoplasms; Prosthesis Failure; Stents; Stomach Neoplasms

A needle made of nitinol has been developed with enhanced flexibility to overcome the limitations of the currently available 19-G EUS-FNA needles.. Evaluate the ability to perform transduodenal FNAs, procure histologic specimens, and undertake therapeutic interventions using the flexible 19-G needle.. Prospective cohort study.. Tertiary-care academic medical center.. Consecutive patients with subepithelial masses, pancreatic head or uncinate lesions, or lesions adjacent to the pancreatic head, and patients undergoing therapeutic intervention.. Perform tissue acquisition and interventions with the flexible 19-G FNA needle.. Evaluate the ability to perform transduodenal passes with the flexible 19-G FNA needle. Also, assess the utility of the needle to yield both cytologic and histologic samples and to perform therapeutic interventions.. Of the 50 patients enrolled, tissue acquisition was undertaken in 38 and therapeutic intervention in 12. Of 38 patients from whom tissue was procured, 32 tissue samples were from pancreatic head/uncinate or peripancreatic masses and 6 were from subepithelial masses. Tissue acquisition, which included transduodenal passes, was successful and adequate for cytologic assessment in all 38 patients (100%). Satisfactory histologic specimens were procured from 36 of 38 (94.7%) patients. An onsite diagnosis was established in 35 of 38 (92.1%) patients. In 3 patients with indeterminate/suspicious lesions, a definitive diagnosis was established at histology. A mean of 1.45 ± 0.79 passes per patient was performed. All 12 therapeutic interventions were successful (100%) and included pseudocyst drainage in 5, pelvic abscess drainage in 2, fiducial placement in 2, celiac plexus neurolysis in 2, and cholangiogram in 1. Needle dysfunction or procedural complications were not encountered.. Single-center study with limited power.. Preliminary data suggest that the flexible 19-G needle can be used for procuring cytologic aspirates and histologic specimens and to undertake therapeutic interventions even by the transduodenal route. Confirmatory studies are required in a larger cohort of patients with varied pathologic conditions to validate these findings.

Topics: Adult; Aged; Alloys; Cohort Studies; Drainage; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Fiducial Markers; Humans; Male; Middle Aged; Needles; Nerve Block; Outcome Assessment, Health Care; Pancreas; Pancreatic Neoplasms; Pancreatitis, Chronic; Pliability; Prospective Studies; Rectal Neoplasms; Stomach Neoplasms

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

This retrospective study estimated the efficacy and safety of the WallFlex duodenal stent for malignant gastric outlet obstruction (GOO) in Japan.. Forty-two consecutive patients with symptomatic malignant GOO were treated using WallFlex duodenal stents between January 2010 and October 2010.. The technical and clinical success rates were 100% and 83.3%, respectively.The median gastric outlet obstruction scoring system increased significantly, from 0 to 2, after stent placement (P < 0.01).The median survival time was 3.3 months (95% confidence interval (CI), 1.8-6.0 months), and the median eating period was 3.0 months (95% CI, 1.1-4.3 months). Re-intervention was required in 11 patients (26.2%). The complication rate was 26.2%. The major complication was stent occlusion (23.8%) by tumor ingrowth, which occurred in nine (21.4%) patients, and tumor overgrowth, which occurred in one (2.4%) patient. Stentmigration, perforation, and food impaction without stent occlusion were not observed.The median survival time of the patients with stent occlusion was 11.7 months (95% CI, 2.2 months - not reached), and the median stent patency of these patients was 4.0 months (95% CI, 0.8-4.7 months).These patients were successfully treated with additional stent insertion using a stent-in-stent procedure.. Duodenal stent placement using a WallFlex duodenal stent was safe and effective for managing malignant GOO.This stent is an uncovered metallic stent, and the major problem was stent occlusion due to tumor ingrowth. However, the occluded stent could be corrected by inserting an additional duodenal stent.

Topics: Aged; Aged, 80 and over; Alloys; Cholangiopancreatography, Endoscopic Retrograde; Contrast Media; Duodenum; Female; Fluoroscopy; Gastric Outlet Obstruction; Gastroscopy; Humans; Japan; Male; Middle Aged; Postoperative Complications; Prosthesis Design; Retrospective Studies; Statistics, Nonparametric; Stents; Stomach Neoplasms; Survival Rate; Treatment Outcome

Self-expandable metallic stents (SEMS) of varying designs and materials have been developed to reduce complications, but few comparative data are available with regard to the type of stent and the stent manufacturer. We analyzed the success rates and complication rates, according to stent type (uncovered vs. covered stent) and individual stent manufacturer, in malignant colorectal obstruction.. From November 2001 to August 2008, 103 patients were retrospectively included in this study: four types of uncovered stents in 73 patients and two types of covered stents in 30 patients. The SEMS was inserted into the obstructive site by using the through-the-scope method.. Technical and clinical success rates were not different between stent type or among stent manufacturers: 100 and 100% (p = ns) and 100 and 96.6% (p > 0.05), respectively, in uncovered and covered stents. Stent occlusion and migration rates were 12.3 and 3.3% (p = 0.274) and 13.7 and 16.7% (p = 0.761), respectively, in uncovered and covered stents, and 11.1, 5, and 9% (p = 0.761) and 25.9, 15, and 0% (p = 0.037) in Wallstent, Niti-S, and Bonastent uncovered stents, respectively.. The placement of SEMS is an effective and safe treatment for patients with malignant colorectal obstruction. Although minor differences in outcome were detected according to the type and the manufacturer of the stents, no statistically significant difference was observed, except in stent migration among the stent manufacturer.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Alloys; Carcinoma; Chromium Alloys; Coated Materials, Biocompatible; Cobalt; Colonic Diseases; Colonic Neoplasms; Colonoscopy; Equipment Design; Female; Fluoroscopy; Foreign-Body Migration; Humans; Intestinal Obstruction; Male; Middle Aged; Palliative Care; Pancreatic Neoplasms; Radiography, Interventional; Rectal Diseases; Stents; Stomach Neoplasms; Treatment Outcome; Uterine Cervical Neoplasms

Topics: Alloys; Anastomosis, Surgical; Esophageal Fistula; Esophagus; Gastroscopy; Humans; Male; Middle Aged; Postoperative Complications; Prostheses and Implants; Reoperation; Stents; Stomach; Stomach Neoplasms; Surgical Instruments; Sutures

To find out whether a newly designed big cup nitinol stent is suitable for treatment of patients with gastric outlet obstruction resulting from gastric cancer.. The new stent is composed of a proximal big cup segment (20 mm in length and 48-55 mm in diameter), a middle part (60 mm in length and 20 mm in diameter) covered by a polyethylene membrane and a distal sphericity (20 mm in length and 28 mm in diameter). Half of the proximal big cup segment is also covered by a polyethylene membrane, which is adjacent to the middle part of the stent. The stent is preloaded in a 6.0-mm-diameter introducer system. Thirteen patients with gastric outlet obstruction resulting from gastric cancer received the new stents under endoscopic and fluoroscopic guidance.. Technical success was achieved in 12 of 13 (92.3%) patients. Among the 12 patients in whom endoscopic stent was placed successfully, the clinical success rate was 91.7% during a follow-up of average 6.5 mo. During the first month follow-up, the migration rate was 0%, recurrent obstruction 0% and gastric bleeding 8.3%. During the follow-up between 2-12 mo, no migration, recurrent obstruction and gastric bleeding occurred.. The proximal big cup segment seems to be effective and promising for technical efficacy, clinical outcome, and preventing migration and tumor ingrowth and increasing the emptying rate of sinus ventriculi.

Topics: Aged; Aged, 80 and over; Alloys; Endoscopy, Gastrointestinal; Female; Follow-Up Studies; Foreign-Body Migration; Gastric Outlet Obstruction; Humans; Male; Neoplasm Invasiveness; Polyethylene; Prevalence; Stents; Stomach Neoplasms; Treatment Outcome

The author reports successful outcomes after percutaneous transhepatic placement of covered, self-expandable nitinol stents in two patients who had afferent loop syndrome caused by recurrent gastric carcinoma. A 46-year-old woman and a 60-year-old man who had undergone subtotal gastrectomy and gastrojejunostomy (Billroth II) were both admitted with symptoms of afferent loop syndrome. In each patient, enhanced abdominal computed tomography showed marked dilation of the jejunal limb and intrahepatic bile ducts incident to recurrent gastric carcinoma. Percutaneous transhepatic biliary drainage was successfully performed, and a multi-sidehole drainage catheter was placed beyond the papilla of Vater. Successful palliation of the afferent loop obstruction was achieved by placing a covered, self-expandable nitinol stent through the transhepatic biliary drainage route. There were no procedure-related complications, and both patients showed clinical improvement.

Topics: Adenocarcinoma; Afferent Loop Syndrome; Alloys; Carcinoma, Signet Ring Cell; Catheterization; Fatal Outcome; Female; Gastrectomy; Hepatic Artery; Humans; Jejunostomy; Male; Middle Aged; Neoplasm Recurrence, Local; Prosthesis Implantation; Stents; Stomach Neoplasms

Through-the-scope (TTS) stents facilitate palliative enteral stent placement. However, most TTS stents are braided, a characteristic that has been associated with significant foreshortening and relatively frequent migration.. To evaluate clinical experience with a new woven enteral stent in the treatment of gastric outlet obstruction.. From January 2005 to August 2006, patients with unresectable malignant gastric outlet obstruction were offered stent placement with a new woven stent.. Three referral hospitals in Japan.. Thirty-seven consecutive patients with malignant gastric outlet obstruction.. A newly designed enteral stent was placed by using the TTS placement technique.. Palliation efficacy and safety of the new stents.. Stent placement was successful in 36 of 37 patients (technical success, 97%). Thirty-four patients were able to tolerate oral intake without obstructive symptoms (clinical success, 94.4%). Complications occurred in 16.2% of patients, comprising 2 cases of primary stent dysfunction, 1 perforation, 1 GI bleeding, 1 stent obstruction, and 1 biliary stent dysfunction. No migration was seen during the median follow-up period of 68 days.. Small sample size and relatively brief follow-up.. A newly developed enteral stent with higher flexibility and less foreshortening offers comparable clinical outcome to existing stents and a lower frequency of complications, including migration.

Topics: Aged; Alloys; Equipment Design; Female; Gastric Outlet Obstruction; Humans; Male; Middle Aged; Palliative Care; Pancreatic Neoplasms; Stents; Stomach Neoplasms; Survival Rate

To assess the technical feasibility, safety, and clinical effectiveness of the placement of expandable metallic stents in patients with anastomotic recurrence of gastric cancer after total gastrectomy with esophagojejunostomy.. The authors retrospectively analyzed data from 32 patients in whom metallic stents were placed for recurrent obstruction after total gastrectomy with esophagojejunostomy. Technical and clinical success and complications with related interventions were evaluated. Overall survival and stent patency rates were calculated according to the Kaplan-Meier method.. Stent placement was technically successful in 30 of the 32 patients (94%). After stent placement, 29 patients (91%) experienced improvement of their symptoms. Fourteen complications occurred after stent placement, and these consisted of pain (n = 5, 16%), stent migration (n = 3, 9%), stent obstruction due to tumor overgrowth (n = 4, 13%), and abutment of the tortuous jejunal wall by the end of the stent (n = 2, 6%). In one of five patients with pain, the stent was removed 4 hours after placement because the pain could not be controlled with analgesics. The median survival and stent patency period were 87.0 and 140.0 days, respectively.. Placement of covered metallic stents in patients with anastomotic recurrence of gastric cancer after total gastrectomy with esophagojejunostomy is technically feasible, safe, and clinically effective.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Anastomosis, Surgical; Deglutition Disorders; Drug-Eluting Stents; Equipment Safety; Esophagostomy; Feasibility Studies; Female; Follow-Up Studies; Gastrectomy; Humans; Jejunostomy; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Recurrence, Local; Palliative Care; Prosthesis Design; Reoperation; Retrospective Studies; Stomach Neoplasms; Treatment Outcome

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 evaluate the treatment of malignant biliary stenoses and occlusions using a new stent.. In a prospective study, 25 patients with malignant obstructive jaundice were treated with SMART(R) stents. The handling and the quality of stent expansion were documented. Stent function was assessed 2 - 4 days after intervention by cholangiography and laboratory tests. A follow-up was performed three months, after stent placement.. All lesions were treated successfully, with a total of 35 stents implanted. In 14 patients a further balloon dilatation was performed after stent placement (8 - 10 mm diameter/ 40 - 80 mm length). The mean serum bilirubin level decreased significantly from 11.6 mg/dl to 4.6 mg/dl after intervention (p < 0.05). The follow-up showed a mean serum bilirubin level at 4.0 mg/dl. In 4 cases (16 %) a further intervention (PTCD or stent) was performed. Six patients died due to tumor progression. The stents proved to be patent in 79 % (n = 15) of patients alive at the time of follow-up.. Placement of the SMART stent for the therapy of malignant biliary lesions yields good technical and clinical results.

Topics: Aged; Aged, 80 and over; Alloys; Bilirubin; Breast Neoplasms; Carcinoma, Hepatocellular; Cholestasis; Colonic Neoplasms; Drainage; Female; Follow-Up Studies; Humans; Klatskin Tumor; Liver Neoplasms; Male; Middle Aged; Pancreatic Neoplasms; Prospective Studies; Radiography; Reoperation; Stents; Stomach Neoplasms; Time Factors

To assess whether coaxial placement of uncovered and covered expandable nitinol stents overcomes the disadvantages of the increased migration rate seen with covered stents and the tumor ingrowth seen in uncovered stents in the treatment of malignant gastric outlet obstructions.. Two types of expandable nitinol stent were designed: an uncovered stent and a covered stent. Under fluoroscopic guidance, the uncovered and covered stents were placed coaxially with complete overlap in 39 consecutive patients with malignant gastric outlet obstruction caused by stomach cancer. Food intake capacity was graded on a scale of 0-4. Stent patency rate was estimated by the Kaplan-Meier method.. Technical success rate was 97% (38 of 39 patients). After stent placement, food intake capacity improved at least one grade in 36 patients. Stent migration occurred in three patients (8%), that is, partial (n = 2) or complete (n = 1) upward migration of the inner covered stent into the stomach. Two of these patients were treated by placement of an additional covered stent. During the mean follow-up period of 134 days (range, 15-569 d), 10 patients developed recurrent symptoms of obstruction with tumor overgrowth being the most common cause. Nine underwent placement of an additional covered stent with good results. The median period of primary stent patency was 157 days (mean, 278 d). The 30-, 60-, and 180-day patency rates were 97%, 91%, and 39%, respectively. Four patients (10%) died within 1 month after the procedure.. Coaxial stent placement technique seems to contribute to decreasing the migration rate of the stent and decrease the rate of recurrent obstruction by preventing or delaying tumor ingrowth.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Equipment Design; Feasibility Studies; Female; Foreign-Body Migration; Gastric Outlet Obstruction; Humans; Male; Middle Aged; Stents; Stomach Neoplasms

To investigate the technical feasibility and clinical effectiveness of a polyurethane-covered expandable nitinol stent in the treatment of malignant gastroduodenal obstructions.. The stent was constructed in-house by weaving a single thread of 0.2-mm nitinol wire in a tubular configuration and was covered with polyurethane solution by means of a dipping method. With fluoroscopic guidance, the stent was placed in 19 consecutive patients with malignant gastric outlet obstruction (n = 15) or duodenal obstruction (n = 4). All patients had severe nausea and recurrent vomiting, and their obstructions were inoperable.. Stent placement was technically successful in all but one patient. After stent placement, symptoms improved in all but one patient, who had another stenosis at the proximal jejunum. One patient with stent placement in the second portion of the duodenum became jaundiced. During the mean follow-up of 11 weeks, stent migration occurred in five patients 1-4 days after the procedure. All patients with stent migration were treated by means of placing a second, uncovered nitinol stent. Two of these five patients showed recurrence of stricture because of tumor ingrowth; they underwent coaxial placement of a third, covered nitinol stent with good results.. Placement of a polyurethane-covered expandable nitinol stent seems to be technically feasible and effective for palliative treatment of inoperable malignant gastroduodenal obstructions. Stent migration, however, is problematic and requires further investigation.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Coated Materials, Biocompatible; Duodenal Neoplasms; Duodenal Obstruction; Feasibility Studies; Female; Gastric Outlet Obstruction; Humans; Male; Middle Aged; Palliative Care; Pancreatic Neoplasms; Polyurethanes; Prosthesis Design; Prosthesis Failure; Pyloric Stenosis; Radiography; Stents; Stomach Neoplasms

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

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

Palliative treatment methods for esophageal and cardiac cancer include dilation, laser vaporization and other thermal methods, alcohol injection, and stent insertion. None of these procedures, however, has proved to be a simple, well-tolerated, and lasting method. We present here our results with a new, highly flexible self-expanding metal stent made of nitinol, which is considered to be particularly useful for difficult (long and tortuous) malignant strictures.. From November 1991 to December 1994, 114 patients with unresectable esophagogastric malignancies or tumor recurrences (92 men, 22 women, mean age 64 years) were treated using 138 highly flexible meshed self-expanding metal stents. Regular clinical and endoscopic follow-up was performed, and stent obstruction or overgrowth was treated by argon plasma coagulation (APC). Patients were followed up until death (n = 78; average follow-up 17 weeks, range 1-90 weeks). Thirty-six patients were alive in December 1994 and had had an average of 20 weeks of follow-up (range 1-160 weeks).. Stent insertion was technically successful in 97% of cases, and led to a reduction of dysphagia (graded 0-4) from a mean score of 3.5 to a mean score of 1.5. Preparatory treatment to open tight strictures was necessary in 80% of cases. Balloon dilation to support stent expansion was carried out in 42 patients (37%). During follow-up, tumor ingrowth occurred in 66% of cases after a mean of seven weeks, and was successfully treated by APC. Including preparatory treatment and re-treatment, patients underwent a mean of 3.5 endoscopic procedures (range 1-12 procedures), which led to good clinical success in 73% of cases. Ninety-six percent of the patients continued to be able to swallow (dysphagia score < or = 2) during follow-up.. Highly elastic self-expanding metal stents can be successfully implanted in the majority of patients, particularly in those with difficult malignant strictures not easily amenable to other methods. The devices provide good palliation with effective relief of dysphagia, easy handling and implantation, and offer a satisfactory quality of life to the patient. However, tumor ingrowth is a significant problem, even though it can be successfully managed by APC. Adequate covering of the stent that does not affect its mechanical properties or firm anchoring should solve at least some of these problems.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alloys; Electrocoagulation; Esophageal Stenosis; Esophagoscopes; Esophagus; Female; Follow-Up Studies; Gastroscopes; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Palliative Care; Stents; Stomach; Stomach Neoplasms; Treatment Outcome

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