I just collect materials of stent insertion for obstructive incurable esophageal cancer. It is retrospectively, so it is difficult to clarify if it's beneficial for relief of dysphagia and a better health-related quality of life. Do you have any good idea to make it useful?
Its a good procedure to help such patients. It gives them a natural route and definitly improves on dysphagia nutritional status.
But stent migration is very common in such patients. They need a check by endoscopy every 2-3 months.Do you have any method to reduce such problem?
Migration is not problem with Boston Stent. Migration could be checked by simple CXR. Usually survival of Ca oesophagus is short.
It's not easy to design a case-control randomized study to confirm the benefit of stent insertion for patients of incurable esophageal cancer.So I am afraid that the retrospective research could not confirm the hypothesis the beneficial of stent insertion.
it will be difficult but possible to do such study retrospectively comparing with those in whom stent was not placed for any reason, it will not be possible to doe such comparison prospectively ethically.
We have introduced about 20 sents in the last one year.They have been cases of advanced unresectable esophageal cancers with dysphagia or tracheo-esophageal fistula, carcinoma oesophagus with obstructing circumferential disease prior to radiation as well as post radiation fibrosis. All patients had good quality of life and no stent migration was noted.
Stenting is easy, safe, rapidly efficient and confortable, providing morphine as needed during stent's expansion.
Be very carefull in case of previous RT and select slowly expanding devices.
Stents with external metal mesh prevent efficiently migration, especially in case of the strent crossing cardia. In this case, always use an antireflux device and be careful not to impact distal end on greater curvature.
Stenting is technically easy performed - helps dysphagia alot...and does help quality of life in some manner...
Would insert semi covered which is the optimum bet ween tissue ingrowth and migration
As with many comments, I find it useful to palliate symptoms and for patients comfort. Life expectancy is short (usually months) after stenting and we had an abstract out several years ago in UEGW which showed continued weight loss with stenting - hence it more for comfort. Stent complication/migration is about 25% on previous studies but I think is getting better. They don't need routine check gastroscopy
We have a positive experience of stenting for palliative cases, thanks largely to the expertise of our interventional radiologists who perform the majority of the procedures. High strictures are very challenging and this is the one group where stenting is often not possible. In cases where resection is still a possibility, we fund that stenting was an independent risk factor for loco-regional recurrence although its difficult to know whether this was because the tumour was advanced (hence needing a stent) or whether the stent may have expanded the tumour towards its radial margin. Chicken and egg difficult to differentiate in this scenario
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