Introduction: Malignant esophageal stricture or compression (ES/C) and malignant tracheoesophageal fistula (TEF) significantly interfere with quality of life. Immediate symptom relief is paramount. We reviewed our experience with esophageal stenting for the management of symptomatic thoracic malignancies.
Methods: We performed an institutional review-board approved, retrospective review of our esophageal stent database. We collected data on patients who underwent esophageal stenting between January 2005 and June 2009. We included only symptomatic patients with malignant ES/C and malignant TEF; we excluded those with radiation-induced TEF. Information regarding patient demographics, diagnosis, clinical history, esophageal symptoms, and post-stent outcomes were analyzed.
Results: During the specified time period we placed 45 esophageal stents (26 silicone and 19 covered nitinol). The major indication was malignant ES from primary esophageal cancer (n=27, 60%); other indications included malignant TEF (n=8, 17.7%), malignant extrinsic compression from primary airway, mediastinal, or metastatic disease (n=7, 15.6%), and other (n=3, 6.7%).
After placement, 24 patients (53.3%) had no additional stenting. The remaining 21 patients (46.7%) required stent-revision procedures for migration (n=12, 26.7%), pain (n=3, 6.7%), dysphagia (n=2, 4.4%), non-seal of TEF (n=2, 4.4%), kink (n=1, 2.2%), and stent erosion (n=1, 2.2%). Thirty-one patients (63.3%) reported subjective relief of pre-stent symptoms. Nine patients (18.4%) received post-stent radiation therapy; 4 had an esophagectomy (8.9%). We had no instances of tumor ingrowth.
There were 2 perforations (4.4%) early in our series. One was from attempted stricture dilation during stent placement, and was fatal; the other resolved. Our overall 30-day mortality was 13%, most often a result of advanced primary disease. Two early deaths were the result of massive hemorrhage.
Conclusion: Esophageal stents are a useful adjunct for immediate palliation in patients with malignant ES/C or TEF. Although they provide symptomatic relief for most patients, migration is an on-going challenge. Technical pearls including absolute avoidance of dilation procedures and the use of covered stents to minimize tumor ingrowth lead to the best results in our experience.
Program Number: P364