A prospective trial of self-expanding metal stents in the palliation of malignant esophageal obstruction after failure of primary curative therapy

Background: Self-expanding metal stents have been shown to be safe and effective for the primary palliation of patients with inoperable malignant esophageal obstruction. We sought to determine their safety and efficacy in patients who fail curative therapy, Methods: Seventeen patients with esophageal carcinoma who had recurrent dysphagia after radiation, surgery, or chemoradiation therapy for esophageal carcinoma were studied. All patients had recurrent dysphagia, and an uncovered metal stent was inserted for palliation. Patients were followed-up at 4-week intervals until death. Palliation was measured by a dysphagia score and the Karnofsky index. Results: Seventeen patients with recurrent dysphagia after primary treatment with surgery (n = 4), radiation (n = 11), and chemoradiation (n = 2) received uncovered Wallstents for palliation of dysphagia. The dysphagia score improved by at least 1 point in all patients. Thirteen of 17 patients had a 2 point improvement in the dysphagia score. The Karnofsky index improved significantly (from 58 +/- 3 to 66 +/- 3, p = 0.0002). Fourteen of the 17 patients had patent stents until death, Three of 12 patients (25%) died of stent-related complications (bleeding in 1, septic complications in 2 patients). Conclusions: Patients with recurrence of esophageal carcinoma after surgery can be successfully treated with metal stents, but patients who have received radiation therapy with curative intent may be at greater risk for complications because of radiation-induced tumor necrosis and vascular changes in the esophageal wall. Larger prospective studies are necessary to clarify this issue.