Temporary Placement of Self-Expanding Oesophageal Stents as Bridging for Neo-Adjuvant Therapy

Felix B. Langer MD, Sebastian F. Schoppmann MD, Gerhard Prager MD, Florian Tomaselli MD, Ursula Pluschnig MD, Michael Hejna MD, Rainer Schmid MD, Johannes Zacherl MD
Gastrointestinal Oncology
Volume 17, Issue 2 / February , 2009

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Abstract

Background

Placement of self-expanding stents is an effective palliation for dysphagia in non-resectable oesophageal or proximal gastric cancer. The aim of this analysis was to assess the efficacy of temporary stent placement for dysphagia relief during neo-adjuvant treatment for locally advanced disease.

Methods

A total of 38 patients scheduled for neo-adjuvant chemo(radio)therapy for locally advanced oesophageal cancer (n = 29), cardia cancer (n = 8) or subcardial gastric cancer (n = 1) underwent placement of self-expanding plastic stents (n = 13) or covered metal stents (n = 25) due to severe dysphagia and weight loss.

Results

Instant dysphagia relief was achieved in 37 (97.4%) of 38 patients. Dysphagia scores declined from mean 3.0 ± 0.7 before stent placement to 0.6 ± 0.9 at restaging. After completion of the neo-adjuvant therapy 20 (52.6%) of the 38 patients underwent resection of the tumour, 5 patients (13.2%) underwent primary resection without receiving chemotherapy while 12 patients (31.6%) did not undergo surgery. Stent-related complications were observed as perforation (n = 1), mediastinitis (n = 1), tracheo-oesophageal fistula (n = 2), bleeding (n = 1) and jejunal perforation caused by a migrated stent (n = 1). Serum albumin significantly decreased in patients with progressive disease despite successful stenting (40.0 ± 4.9 mg/dl versus 29.7 ± 6.4 mg/dl, p < 0.05) while stable albumin levels were found in patients who underwent surgery (39.9 ± 4.3 mg/dl versus 39.1 ± 3.8 mg/dl, p = 0.484).

Conclusion

Placement of self-expanding stents is highly effective for instant dysphagia relief, enabling adequate oral nutrition during neo-adjuvant therapy, but is limited by a high re-intervention rate.

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