悪性食道狭窄に対する自己拡張型金属ステント療法 : 臨床的有用性の検討

Self-expandable metallic stents were used for palliative treatment of malignant esophagogastric strictures. Twelve patients, nine men and three women, with a mean age of 73.1 years old (range, 48-87 years old) had dysphagia due to esophagogastric strictures with advanced malignant tumors. A total of 13 expandable metallic stents were placed, four non-covered Ultraflex stents (nitinol stents), two non-covered Wallstents and seven covered Wallstents. The strictures were caused by esophageal carcinoma (n=7), gastric carcinoma with lymphnode metastasis (n=2), lung carcinoma with mediastinal lymphnode metastasis (n=2), and cardioesophageal carcinoma (n=1). All stents were placed with fluoroscopic and endoscopic guidance. No technical failure or procedural critical complications occurred and the dysphagia was relieved in all patients. The mean dysphagia score was 0.58±0.52 (standard deviation) before treatment and 3.25±0.97 after insertion. Complications included chest and epigastric pain in four, gastroesophageal reflux in two, tumor ingrowth in one, and food impaction in one. Six complications easily managed with medical, endoscopic, or radiologic intervention. At the end of this study, eight patients were dead with a mean survival of 28.3 weeks (range, 4-96 weeks), and four patients were alive with a mean follow up of 35.5 weeks (range, 8-98 weeks).
In our experience, self-expandable metallic stents provide relatively safe and long-term palliation in patients with malignant esophagogastric obstruction.