Esophageal carcinoma: initial results of palliative treatment with covered self-expanding endoprostheses

To assess the effectiveness of a polyurethane-covered self-expanding metallic endoprosthesis in the relief of dysphagia due to irresectable esophageal carcinoma.

Thirty-two patients (20 men, 12 women) aged 41-89 years (median, 70 years) with inoperable esophageal carcinoma underwent stent placement (44 stents). All patients underwent both clinical and radiologic examination before and after treatment. Clinical follow-up was performed at 4-week intervals.

Stent placement was successful in all patients, with good symptomatic relief and no serious complications. Eleven patients needed more than one stent because of early partial migration, late complete migration, tumor overgrowth, or long stricture. Seven patients had associated esophageal fistulization or perforation; leaks were successfully sealed after stent insertion. The mean dysphagia score was 3.38 +/- 0.49 (standard deviation) before treatment and 0.81 +/- 0.88 at 3-4 days after insertion. Nineteen patients died, with a median survival time of 78 days (range, 12-245 days), and 13 were alive 14-67 days (median, 30 days) after treatment and were swallowing a near normal diet.

The insertion of plastic-covered endoprostheses provides rapid, safe, and effective palliation of malignant esophageal obstruction.