Abstract
We evaluated the expandable metallic stent (EMS, GIANTURCO-RÖSCH Z-STENTS, 12mm in diameter, Cook, Bloomington, IN, USA) for use as an endoprosthesis in esophageal stricture, in comparison with a plastic prosthesis (PPS, ESOPHAGEAL PROSTHESIS, 14mm in diameter, Sumitomo, Tokyo, Japan). From April 1987 to March 1995, EMS was intubated in three patients with esophageal stricture caused by lymph node metastasis from colon cancer, corrosive esophagitis and primary esophageal cancer, respectively. An additional three patients were intubated with PPS for esophageal strictures due to primary esophageal cancer, recurrence of gastric cancer and invasion of cardiac cancer, respectively. EMS and PPS were intubated under local or general anesthesia. One of the three patients intubated with EMS was able to ingest semisolid food after treatment, but the other two patients could not ingest food because of restenosis and reflux esophagitis. A bronchoesophageal fistula developed in one patient treated with EMS and migration occurred in another. On the other hand, two out of the three patients intubated with PPS were able to ingest semisolid food following this procedure, although the other patient could not because of ileus due to peritonitis carcinomatosa. Restenosis of the distal edge of the plastic prosthesis caused by tumor growth occurred in one case and mild reflux esophagitis in another. The insertion of EMS was easy to perform but the removal was impossible. Intraluminal restenosis occasionally occurred in EMS, but not in the PPS intubated patients. The insertion of PPS was necessary under general anesthesia on a case by case basis. In general, migration, bleeding and penetration occurred in both groups. For the management of esophageal stricture, a good knowledge of the characteristics of the endoprosthesis (EMS or PPS) and its selection criteria are important. The indication for an esophageal endoprosthesis should be carefully determined.
