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

• Published in: Arab journal of gastroenterology Vol. 20; no. 1; pp. 28 - 31
• Main Authors: Markos, Pave, Sisko Markos, Ines, Ivekovic, Hrvoje, Bilic, Branko, Rustemovic, Nadan
• Format: Journal Article
• Language: English
• Published: Egypt Elsevier B.V 01.03.2019
• Subjects: Aged; Aged, 80 and over; Deglutition Disorders - etiology; Deglutition Disorders - therapy; Dysphagia; Esophagus - pathology; Female; Humans; Lung cancer; Lung Neoplasms - complications; Lung Neoplasms - pathology; Lymphatic Metastasis; Male; Malignant oesophageal stricture; Mediastinum; Middle Aged; Neoplasm Invasiveness; Palliative Care; Quality of Life; Self Expandable Metallic Stents - adverse effects; Self-expandable metal stents; Survival Rate; Tracheoesophageal Fistula - etiology; Self-expandable metal stents; Dysphagia; Lung cancer; Malignant oesophageal stricture
• ISSN: 1687-1979; 2090-2387
• DOI: 10.1016/j.ajg.2019.01.004

We intended to evaluate the role of self-expandable metal stents (SEMS) for palliation of malignant dysphagia in patients with lung cancer. 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. 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. Placing SEMS in patients with lung cancer is safe and highly effective in relieving dysphagia with significant improvement in quality of life.