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Esophageal Stent: an Essential Tool in Treatment of Complex Esophageal Disease
Farzaneh Banki2,1, Victoria Chang*2, Sri Naveen Surapaneni1, Chandni Kaushik2, Charles Miller2
1Memorial Hermann Southeast Esophageal Disease Center, Houston, TX; 2University of Texas Health Science Center at Houston, Houston, TX
Objective: To assess the role of esophageal stenting in treatment of esophageal disease
Methods: Retrospective chart review and a follow up symptomatic questionnaire via phone.
Results: From 03/05/2010 to 11/24/2015, 105 esophageal stents were placed in 41 patients. Values are presented as median and interquartile range (IQR). There were 28 males and 13 females with median age of 66(56-71). The ASA classification was 3 (3-4). The median number of stents per patient was 1(1-3). The median length of stent was 14(10.5-15.5) cm and the diameter 23(18-23) mm. There were 63 fully and 42 partially covered stents. There were 98 procedures with median number of 1(1-3) per patient and duration of 31(22-39) min. The indications included stricture in 21 [11 malignant and 10 benign], esophageal perforation in 12, tight fundoplication in 7, anastomotic leaks in 5, tracheoesophageal fistula (TEF) in 2 and esophagogastric fistula in 1. In 6 patients there was more than one indication.
The complications included 21 migrated stents, stricture caused by mucosal damage incurred during removal of the partially covered stent in 2 patients, TEF caused by thoracic esophagogastric anastomotic leak in 1, and aortoesophageal fistula in 1. Predictors of migration were male gender (OR 7.5, p<0.03) and use of a fully covered stent (OR 5.6, p<0.04).
The median duration of treatment was 1.5 (1-3) months. There were two 30 day mortalities, one caused by aortoesophageal fistula and one by heart failure.
At the time of follow up symptomatic questionnaire via phone there were 11 deaths (two related: one due to tracheoesophageal fistula caused by the stent and one due to anastomotic leak). The questionnaire was completed in 21 patients at 14 (3-25) months.
While the stent was in place 11 were asymptomatic. The main symptoms were regurgitation in 5, pain in 4 and dysphagia in 1. Regurgitation was significantly more common in females (7/10) vs males (1/11) p<0.008. All patients with pain required narcotic medication. 14 were able to eat as desired and 14 were able to perform daily activity.
At the time of questionnaire, the median weight change was 0(-10 to 5) lbs. Dysphagia was reported in 3, regurgitation in 2, heartburn in 2, pain in 1 and nausea in 1. 18 were able to eat as desired, 18 were free of preoperative symptoms and 17 were satisfied.
Conclusions:
Esophageal stent is an essential tool in treatment of complex esophageal disease and provides adequate treatment in majority of cases, potentially preventing further surgical intervention. The most common complication is migration, more commonly in males and with fully covered stents. The main symptom is regurgitation which occurs more common in females, followed by pain requiring narcotic medication. The possibility of fistula to the aorta or the trachea should be considered for stents in the thoracic esophagus.
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