Feasibility, efficacy and safety of stent insertion as a palliative treatment for malignant strictures in the cervical segment of the esophagus and the hypopharynx

Battaglia, G. and Antonello, A. and Realdon, S. and Cavallin, F. and Giacomini, F. and Ishaq, S. (2016) Feasibility, efficacy and safety of stent insertion as a palliative treatment for malignant strictures in the cervical segment of the esophagus and the hypopharynx. Surgical Endoscopy and Other Interventional Techniques, 30 (1). pp. 159-167. ISSN 09302794 (ISSN)

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Background: 50% of esophageal cancers are inoperable at the time of diagnosis, and around 15% involve the cervical esophagus. The hypopharynx is often involved by these malignancies as well. Palliation of cervical esophageal malignancies through stent insertion is considered limited due to technical challenges, poor patient tolerance and high complication rate. The aim of this study is to review our experience with stent insertion in the cervical segment of the esophagus and to evaluate outcome differences between stent insertions involving or sparing the hypopharynx. Methods: We retrospectively reviewed data on 69 consecutive patients that underwent stent insertion for malignant strictures in the cervical esophagus at our Department. Patients were divided according to involvement or sparing of the lower hypopharynx. Dysphagia severity was measured with the Mellow-Pinkas scale before the procedure and on monthly follow-ups. Any complication and its management were recorded. The main outcome parameters were as follows: dysphagia improvement, rate of successful dysphagia palliation (i.e., a reduction of the score to 0 or 1 after stent insertion) and complication rate. Multivariable analysis was carried out to assess the influence of patient- and procedure-related factors on the outcome of the procedure. Results: Stent insertion was achieved in 100% patients. At 4 weeks, dysphagia score improved from a median of 3-0 (p < 0.001), and a successful palliation was achieved in 76.8% patients. The 30-day mortality rate was 14.5%. Successful palliation throughout the follow-up was achieved in 72.9% of the surviving patients. Complications occurred in 31.9% patients. Dilation before stent insertion was associated with a less efficient short-term dysphagia palliation (OR 6.77, 95% CI 1.46-31.29, p = 0.02). Conclusions: Stent insertion is a safe and effective palliative treatment for malignant cervical esophageal strictures. Results are consistent even in patients with hypopharyngeal lesions. Dilation should be avoided before stent insertion. © 2015, Springer Science+Business Media New York.

Item Type: Article
Identification Number: https://doi.org/10.1007/s00464-015-4176-z
1 January 2016Published
1 April 2015Published Online
19 March 2015Accepted
Uncontrolled Keywords: Endoscopy, gastrointestinal, Esophageal neoplasms, Esophageal sphincter, upper, Palliative care, Stents, ketorolac, paracetamol, ablation therapy, adult, aged, argon plasma coagulation, Article, aspiration pneumonia, bleeding, blood transfusion, cancer growth, cancer localization, cancer mortality, cancer palliative therapy, cancer size, cancer survival, clinical effectiveness, clinical feature, debridement, device safety, disease severity, drug treatment failure, dysphagia, esophageal stent, esophagus cancer, esophagus fistula, esophagus stenosis, female, follow up, food impaction, gastroscope, human, hypopharynx, intestine obstruction, major clinical study, male, malignant cervical esophageal stricture, mortality rate, outcome assessment, pain, percutaneous endoscopic gastrostomy, perforation, priority journal, respiratory failure, respiratory tract fistula, retrospective study, stent migration, survival rate, trachea compression, tracheobronchial stent
Subjects: CAH01 - medicine and dentistry > CAH01-01 - medicine and dentistry > CAH01-01-01 - medical sciences (non-specific)
Divisions: Faculty of Health, Education and Life Sciences > School of Nursing and Midwifery
Depositing User: Users 18 not found.
Date Deposited: 08 Nov 2016 12:17
Last Modified: 03 Mar 2022 15:37
URI: https://www.open-access.bcu.ac.uk/id/eprint/546

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