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

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

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