Self-expandable metal stent for dysphagia caused by mediastinal masses in patients with lung cancer

Pave Markos; Ines Sisko Markos; Hrvoje Ivekovic; Branko Bilic; Nadan Rustemovic

doi:10.1016/j.ajg.2019.01.004

Self-expandable metal stent for dysphagia caused by mediastinal masses in patients with lung cancer

Arab J Gastroenterol. 2019 Mar;20(1):28-31. doi: 10.1016/j.ajg.2019.01.004. Epub 2019 Feb 4.

Authors

Pave Markos¹, Ines Sisko Markos², Hrvoje Ivekovic³, Branko Bilic³, Nadan Rustemovic³

Affiliations

¹ Endoscopy Unit, Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Croatia. Electronic address: pave.markos@gmail.com.
² Department of Oncology and Nuclear Medicine, University Hospital Sisters of Mercy, Zagreb, Croatia.
³ Endoscopy Unit, Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Croatia.

PMID: 30733178
DOI: 10.1016/j.ajg.2019.01.004

Abstract

Background and study aims: We intended to evaluate the role of self-expandable metal stents (SEMS) for palliation of malignant dysphagia in patients with lung cancer.

Patients and methods: During the period between May 2015 and September 2017, 42 SEMS have been placed for malignant dysphagia in patients with lung cancer. Stents have been placed under combined fluoroscopic and endoscopic guidance.

Results: Data from 42 patient were analysed. 35 patients (83%) were males and the mean age was 68,4 years (range 52-80 y). In 26 patients (61%) cause of dysphagia was extraluminal mediastinal lymphadenopathy and in others direct tumour infiltration of the oesophagus. A tracheo-oesophageal fistula (TEF) was seen in 8 patients (19%). Most of the patients (32 patients; 76%) had stage 3 dysphagia (able to swallow liquids only) and the rest (10 patients; 24%) stage 4 (unable to swallow saliva). Thirty stents (71%) were partially covered and 12 (29%) were fully covered. Five (12%) stents have been placed across the oesophagogastric junction due to infiltration of the cardia. There were no immediate complications except for aspiration pneumonia in 3 (7%) and minor bleeding in 2 (5%) patients which resolved spontaneously. Dysphagia score improved in all patients to stage 1 (dysphagia with certain solid food in 16 patients-38%) or stage 2 (able to swallow semi solid in 26 patients-62%). In 3 (7%) patients during the follow-up we encountered tumour overgrowth and in 1 patients the TEF was not sealed so they have been referred for gastrostomy. No other long term complications were recorded. Most of the patients (30 patients- 71%) died during the follow-up, with mean survival of 4 months (range 2-9) after the stent placement.

Conclusion: Placing SEMS in patients with lung cancer is safe and highly effective in relieving dysphagia with significant improvement in quality of life.

Keywords: Dysphagia; Lung cancer; Malignant oesophageal stricture; Self-expandable metal stents.

MeSH terms

Aged
Aged, 80 and over
Deglutition Disorders / etiology*
Deglutition Disorders / therapy*
Esophagus / pathology*
Female
Humans
Lung Neoplasms / complications
Lung Neoplasms / pathology*
Lymphatic Metastasis
Male
Mediastinum
Middle Aged
Neoplasm Invasiveness
Palliative Care
Quality of Life
Self Expandable Metallic Stents* / adverse effects
Survival Rate
Tracheoesophageal Fistula / etiology*