Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 28, 2012; 18(28): 3732-3737
Published online Jul 28, 2012. doi: 10.3748/wjg.v18.i28.3732
Double layered self-expanding metal stents for malignant esophageal obstruction, especially across the gastroesophageal junction
Min Dae Kim, Su Bum Park, Dae Hwan Kang, Jae Hyung Lee, Cheol Woong Choi, Hyung Wook Kim, Chung Uk Chung, Young Il Jeong
Min Dae Kim, Jae Hyung Lee, Department of Internal Medicine, Bongseng Memorial Hospital, Busan 601-723, South Korea
Su Bum Park, Dae Hwan Kang, Cheol Woong Choi, Hyung Wook Kim, Chung Uk Chung, Young Il Jeong, Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 626-770, South Korea
Author contributions: Kim MD and Park SB contributed equally to this work; Kim MD, Park SB and Kang DH designed the research; Kim MD, Park SB, Kang DH, Lee JH, Choi CW, Kim HW, Chung CU and Jeong YI performed the research; Kim HW and Choi CW analyzed the data; and Kim MD and Park SB wrote the paper.
Supported by A grant from the Korea Healthcare Technology R and D Project, Ministry for Health, Welfare and Family Affairs, South Korea, No. A091047
Correspondence to: Dae Hwan Kang, PhD, MD, Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan 626-770, South Korea. sulsulpul@yahoo.co.kr
Telephone: +82-55-3601535 Fax: +82-55-3601536
Received: December 5, 2011
Revised: February 1, 2012
Accepted: April 13, 2012
Published online: July 28, 2012
Abstract

AIM: To evaluate the clinical outcomes of double-layered self-expanding metal stents (SEMS) for treatment of malignant esophageal obstruction according to whether SEMS crosses the gastroesophageal junction (GEJ).

METHODS: Forty eight patients who underwent the SEMS insertion for malignant esophageal obstruction were enrolled. Patients were classified as GEJ group (SEMS across GEJ, 18 patients) and non-GEJ group (SEMS above GEJ, 30 patients) according to SEMS position. Double layered (outer uncovered and inner covered stent) esophageal stents were placed.

RESULTS: The SEMS insertion and the clinical improvement were achieved in all patients in both groups. Stent malfunction occurred in seven patients in the GEJ group and nine patients in the non-GEJ group. Tumor overgrowth occurred in five and eight patients, respectively, food impaction occurred in one patient in each group, and stent migration occurred in one and no patient, respectively. There were no significant differences between the two groups. Reflux esophagitis occurred more frequently in the GEJ group (eight vs five patients, P = 0.036) and was controlled by proton pump inhibitor. Aspiration pneumonia occurred in zero and five patients, respectively, and tracheoesophageal fistula occurred in zero and two patients, respectively.

CONCLUSION: Double-layered SEMS are a feasible and effective treatment when placed across the GEJ for malignant esophageal obstruction. Double-layered SEMS provide acceptable complications, especially migration, although reflux esophagitis is more common in the GEJ group.

Keywords: Metal stent, Gastroesophageal junction, Malignant esophageal obstruction