Ultraflex stent: Benefits and risks in ultimate palliation of advanced, malignant stenosis in the esophagus

Background/Aims: Sophisticated endoscopical palliation in end-stage maligmant stenosis of the esophagus and gastroesophageal-junction must be weighed against associated morbidity and mortality. In a prospective study we investigated henefits and risks of one type of coated, self-expendable stent in ultimate palliation of esophageal neoplasms focusing on factors that might predispose patients to develop complications. Methodology: 33 men (70.2%) and 14 women (29.8%), (mean age 68.3 years, range from 38 to 90 years), suffering from nonresectable malignant stenosis of the esophagus due to advanced tumor stage and/or functional inoperability were treated by using a covered, self-expandable stent (covered ULTRAFLEX esophageal stent system, Microinvasive. Boston Scientific Corporation, Boston, MA). Stenting was indicated because of severe dysphagia for liquids and saliva in 41 (87.2%) patients, tracheoesphageal fistula in 5 (10.6%) patients and in one case of tumor bleeding (2.1). 32 out of 47 patients bad had one or other multiple treatment modulithes before scenting. In 15 patients stenting was the first and only therapeutic option. Results: All patients experienced an improvement of dysphagia immediately after stenting. Eight out of 47 patients (17.1%) developed major stent-associated complications. Early complications within 4 days after implantation evolved in two eases, with one patient dying from stent-induced perforation with consecutive mediastinitis and multi-organ failure. Late complications (20 to 180 days after stent implantation) occurred in 6 cases: Three esophagotracheal flstulae (two with tracheal compression) induced by stent expansion, one stent-induced bleeding and two stent dislocations. After appropriate complication management all but two patients were able to be discharged after a mean of 2.6 days. Multivariate analysis did not show any factors that might have predicted the development of major stent-associated complications. Conclusions: Implantation of the self-expandable Ultraflex-stent will efficiently palliate dysphagia, bleeding and fistulae. The 17% risk of major complications seems acceptable regarding the inherent problems of alternative treatment options, like gastrostomy PEG, nasogastric tube or long-term parenteral feeding.