Original article
Clinical endoscopy
Placement of Polyflex stents in patients with locally advanced esophageal cancer is safe and improves dysphagia during neoadjuvant therapy

https://doi.org/10.1016/j.gie.2009.01.026Get rights and content

Background

Patients with locally advanced esophageal cancer who require neoadjuvant therapy have significant dysphagia.

Objectives

To prospectively evaluate Polyflex stents to treat malignant dysphagia and to ameliorate weight loss in patients with locally advanced esophageal cancer who will undergo neoadjuvant therapy.

Design

A prospective nonrandomized study.

Setting

Tertiary-referral cancer center.

Patients

Thirteen patients with esophageal cancer (11 adenocarcinoma, 2 squamous-cell carcinoma). All patients were men, with a mean age of 63 years.

Interventions

EUS followed by stent placement.

Main Outcome Measurements

Dysphagia scores and patient weights.

Results

There were no perforations and no episodes of bleeding. Immediate complications included chest discomfort in 12 of 13 patients. The mean dysphagia score at the time of stent placement was 3. Mean dysphagia scores obtained at 1, 2, 3, and 4 weeks after stent placement were 1.1 (P = .005), 0.8 (P = .01), 0.9 (P = .02), and 1.0 (P = .008), respectively. Stent migration occurred at some point in 6 of 13 patients (46%).

Limitations

A single center and small size of study.

Conclusions

Simultaneous EUS staging and Polyflex stent placement is safe and allows oral feeding during neoadjuvant therapy. Dysphagia scores improved in a statistically significant manner. Stent migration was a common event, although not all patients with a migrated stent will require stent replacement, because migration may be a sign of tumor response to neoadjuvant therapy.

Section snippets

Patients

This study was performed at the University of Utah School of Medicine/Huntsman Cancer Center. Between April 2006 and November 2007, patients referred for EUS staging who met entry criteria were enrolled in the study. Patients were observed until death or stent removal, or until 6 months had elapsed after stent placement (whichever came first). Informed consent was obtained before EUS. Inclusion criteria were the following: (1) patients ≥18 years of age, with biopsy-confirmed esophageal cancer

Results

During the study period, 31 patients were referred for evaluation of esophageal cancer. Patients with disease that was unresectable at presentation were not offered enrollment in the study. All patients who were potential surgical candidates and in whom neoadjuvant therapy was planned were offered enrollment, and this constituted the 13 patients who met entry criteria and were enrolled in the study. All patients were men, with a mean (SD) age of 63.3 ± 12.3 years (range 45-83 years). Eleven

Discussion

Most patients with locally advanced esophageal cancer have malignant dysphagia, and the current standard of care in the United States is to offer these patients neoadjuvant therapy.7, 8 The goal of such therapy is to decrease tumor burden and to eradicate malignant lymphadenopathy.9 Neoadjuvant therapy can improve dysphagia symptoms via decreasing tumor size and increasing the esophageal luminal diameter, but this can take time. In addition, some patients will experience a worsening of their

References (26)

  • A. Pennathur et al.

    Polyflex expandable stents in the treatment of esophageal disease: initial experience

    Ann Thorac Surg

    (2008)
  • M.H. Mellow et al.

    Endoscopic laser therapy for malignancies affecting the esophagus and gastroesophageal junction. Analysis of technical and functional efficacy

    Arch Intern Med

    (1985)
  • P.D. Siersema et al.

    Treatment of locally advanced esophageal cancer with surgery and chemoradiation

    Curr Opin Gastroenterol

    (2008)
  • Cited by (67)

    • Toxicity and Outcomes in Patients With and Without Esophageal Stents in Locally Advanced Esophageal Cancer

      2017, International Journal of Radiation Oncology Biology Physics
      Citation Excerpt :

      Less common, but serious, side effects include esophageal perforation, fistula, abscess, and death (12, 14, 15). Although initially used in the palliative setting (16, 17), esophageal stenting has been increasingly used in the curative setting and as a bridge to surgery (9-12, 14, 15, 18-20). CRT, either definitive or neoadjuvant, remains the standard of care for locoregionally advanced esophageal cancer; however, insufficient data are available regarding the safety and benefit of esophageal stenting in this setting.

    • Enteral Access is not Required for Esophageal Cancer Patients Undergoing Neoadjuvant Therapy

      2016, Annals of Thoracic Surgery
      Citation Excerpt :

      Newer-generation self-expanding silicon stents may be repositioned or removed, and they may avoid some of the adverse events associated with metal stents such as perforation and negative impact on oncologic outcomes [6, 29]. Silicone stents have been used to treat esophageal anastomotic leaks, strictures, and dysphagia from esophageal malignancy [6, 9, 31]. Although silicone stenting may be an attractive option, some patients may have a nondilatable stricture or other considerations precluding placement.

    • Gastrointestinal stenting: Current status and imaging features

      2015, Diagnostic and Interventional Imaging
    • Preliminary results of temporary placement of retrievable expandable metallic stents during preoperative neoadjuvant chemoradiotherapy in patients with resectable esophageal cancer

      2015, Journal of Vascular and Interventional Radiology
      Citation Excerpt :

      However, there were complications secondary to stent obstruction, such as tumor overgrowth, granulation tissue formation, and food impaction, because of short duration of stent placement as well as reduction of tumor burden by neoadjuvant CRT. Our stent-related complication rate was slightly lower than in previous studies, especially the stent migration rate (20% in our study vs 24%–46% in previous studies) (6–9). Mean duration of temporary stent placement in our study was also shorter than in previous studies (4–6 weeks in our study vs 6.4–12.7 weeks in previous studies) (6,7).

    • Self-expanding covered metallic stent as a bridge to surgery in esophageal cancer: Impact on oncologic outcomes

      2015, Journal of the American College of Surgeons
      Citation Excerpt :

      For operable disease, many surgeons are reluctant to consider stents, expressing concerns about perforation, difficulties in surgical dissection, and future tumoral resectability. Despite this, some studies have examined the role of stents as a bridge to surgery and reported that their insertion can be performed with safe early results, but none of these studies reported data on oncologic outcomes (Table 4).7-16 The current study is the first to show that SEMS placement negatively impacts oncologic outcomes, with significantly lower R0 resection rates, time to recurrence, and OS, and significantly higher rates of locoregional recurrence.

    View all citing articles on Scopus

    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

    If you would like to chat with an author of this article, you may contact him at [email protected]; [email protected].

    View full text