Purpose
Endo-esophagus stent transplantation has been one of the appeasable options to the patient with malignant stricture. 12 cases of esophageal stricture were reviewed to evaluate clinical effect and safety of membrane coated thermo-memorial alloyed stent for malignant and benign esophageal stricture.
Material and methods
12 patients (4 female, 8 male) with esophageal stricture were aged from 32~69 yeas old (mean 54.6 Y). There were 2 of benign stricture and 10 of malignant strictures which include 6 simplex, 2 anastomoses postoperative and 2 esophageal pleural fistula strictures. Home-made thermo-memorial alloyed stents with coated membrane were customized as 16~20mm in diameter and 80~160mm in length. Preoperative esophagography with barium meal or liquid contrast medium were taken in A-P view and bi-oblique view positions for measurement. The length was customized 2~4 cm longer than scope of the lesion for the sake of recurrent growth. Operation began 15 minutes after Atropin 15 mg was injected and faucial anesthesia atomized. A strengthening balloon (30mm in diameter) catheter with guide wire was introduced through mouth. The two mark points of balloon were located to cover the both ends of lesion under fluoroscopy. The strength balloon was inflated with contrast medium maintaining 5~10 minutes properly several times at 5~10 minutes interval. The graded tapered dilators were also applied instead of balloon catheter. Thermo-memorial alloyed stent was cooled in the ice water to be softened, and then retracted into sheath. A roll booster helped to pull the stent into the prospective position of esophagus according to the marks along the guide wire gently. Under fluoroscopic guidance, released the stent carefully as withdrawing the sheath. The stent expanded automatically by the animal heat and strengthened adhering the lining of the esophagus gradually. Withdrawing the roll booster and taking esophagography documented.
Results
1. The reaction during operation: evidently widening of the stricture in diameter presented with 100% validity. “Wasp waist” was presented at the operation same day in 3 cases and the stents were expanded about ¾ in diameter. Complete expanded were showed in the third day. All patients experienced the endurable pain under-sternum without medicine applied during operation, no hemostatic management required . 2. Postoperative reaction: the stents were located satisfactorily, the pain was released gradually in 1~2 week. Constrictive feeling was complained lasting months without lessening in 2 cases. Fistula was isolated at once in 1 of 2 patients, and another case was covered only one spot of two fistulae. 3. Following-up: 8/10 cases of malignant stricture were followed. The mean survival period above 5.5 month without dysphageal. 4 cases died of the malignant systemic failure; 1 case died of severe infection caused by uncovered fistula. 1 coated membrane was lifted on both end of stricture by recurrent tumor after 6 months, but without dysphageal and dislocation of the stent. An ulcer in 1 of the two cases with benign stricture was covered properly and healing without recurrent; another patient experienced post sternum pain lasting 2 months and released without re-stricture.
Conclusion
Membrane coated thermo-memorial alloyed stent is beneficial to the ulcer and fistula of malignant and benign esophageal stricture. The delivery procedure is manageable and safety. It is one of the appeasable options to the patient with malignant stricture.