[Esophageal and gastrointestinal application of traditional and metal prostheses]

The endoscopic prosthesis implantation in malignant oesophago-gastrointestinal stenoses is an important palliative therapeutic method. Even with traditional prosthesis placement in the last 10 years the application of metal prosthesis is more and more frequent.

In this article the authors summarise their experiences with traditional and metal prosthesis implantations between September of 1991 and November of 2002. In the last 11 years 180 prostheses were implanted for 152 patients. Out of these 130 were traditional and 50 were metal prosthesis. The traditional prostheses were implanted with balloon catheter introducer following dilatation up to 17-18 mm with balloon and Savary bougie. The metal prostheses were implanted after balloon catheter dilatation up to 14 mm. The cause of stenosis in 61 cases were inoperable or recurrent oesophageal cancer, in 45 gastric cancer, in 38 cases oesophageal compression or infiltration by lung cancer, mediastinal metastases due to breast cancer in 7 and kidney cancer in 1 case. 111 prostheses were implanted in to the oesophageal, 24 cardial, 3 gastro-enteral, 8 oesophago-jejunal, 6 jejunal stenoses.

Due to the stent implantation the patients average dysphagia score decreased from 2.85 (SD = 0.7) to 1.0 (SD = 0.6). From our patients 33 had oesophago/gastro--respiratoric/mediastinal/thoracocutaneous fistula. Out of these 26 were successfully closed with metal prosthesis and 5 out of 7 with traditional prostheses. The severe early complications with traditional prosthesis (5 perforation, 2 hydropneumothorax, 1 mediastinal and subcutaneous emphysema) were in 6.2% of the cases. From 8 patients 4 healed after drainage, 3 following conservative therapy and 1 died. Early, severe complication, thoracic empyema was observed in one patient from 50 implanted metal stent. The patient died after surgical drainage. In 2 patients as a severe late complication with Wallstent, severe bleeding occurred, and in 2 patient at the funnel of a traditional stents, 3 esophago-tracheal fistulas developed. Furthermore there were stent dislocations (17/152) and stent obstructions (15/152) all together (32/152) in 21% of the cases.

The implantation of traditional prostheses method used by the authors runs with low risks and gives good results. Implantation of metal stent is easier, less burden for the patient and considerably decreasing the risk of early, severe complications, widening the application territory for prostheses. In the frequency of late complication however there is no significant difference between the methods.