Self-Expandable Metal Stents in Palliation of Malignant Esopageal Obstruction

Khalid Hameed, Hashmatullah Khan, Rahman Ud Din, Jandil Khan, Adnan Ur Rehman, Murad Rashid


Background: More than half patients with carcinoma esophagus are inoperable at the time of presentation. A number of treatment options are available to relieve dysphagia. The aim of this study was to evaluate the results of self expandable metal stents for the treatment of malignant dysphagia.

Material & Methods: This descriptive study was conducted at Gastroenterology Department, Hayatabad Medical Complex Peshawar from January 2006 to August 2009. Thirteen patients with grade 3 or 4 dysphagia due to inoperable carcinoma esophagus underwent Self Expandable Metal Stenting under endoscopic guidance. They were followed for one month. Dysphagia score was calculated at baseline and at follow up according to Atkinson’s scale. Patients were assessed for complications. Data was analyzed using SPSS version 10.

Results: Mean age of patients was 47.5±15 years with male to female ratio of 1:1.6. Mean dysphagia score improved from 3.4 (pre-stent) to 1.07 (post-stent) (p <0.05). Improvement in dysphagia (conversion of grade 3 or 4 dysphagia into grade 1 or 0) was seen in 92.3% patients. Perforation occurred in one patient. Three patients required re-intervention after initial improvement; two for their stent blockage (15.4%) and one for stent migration (7.7%). Other minor complications like cough and regurgitation occurred in 15.4% and 38.5% patients respectively. Thirty-one percent of patients experienced severe chest pain necessitating narcotic analgesics.

Conclusion: In patients with inoperable carcinoma esophagus self expandable metal stents are an effective method for palliation of dysphagia but not without complications.

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