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  • Title: Self-expanding metal stents for malignant esophagogastric obstruction: experience with a new design covered nitinol stent.
    Author: Keller R, Flieger D, Fischbach W, Christl SU.
    Journal: J Gastrointestin Liver Dis; 2007 Sep; 16(3):239-43. PubMed ID: 17925915.
    Abstract:
    BACKGROUND AND AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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