PLASTIC-COVERED METALLIC ENDOPROSTHESES IN THE MANAGEMENT OF ESOPHAGEAL-PERFORATION IN PATIENTS WITH ESOPHAGEAL-CARCINOMA

Objective: To evaluate the role of plastic-covered self-expanding metallic endoprostheses in patients with oesophageal perforation occuring during endoscopically guided dilatation prior to laser treatment for malignant obstruction. Subjects and methods: Six patients with oesophageal perforation following laser treatment for malignant obstruction were treated, Four patients received the polyurethane-covered Wallstent endoprosthesis (Schneider SA, Bulach, Switzerland) and two patients the barbed polyethylene-covered Gianturco stent (William Cook, Europe). Results: All patients had successful stent placement under intravenous sedation and fluoroscopic guidance with immediate relief of dysphagia and sealing of the perforation, Following the procedure all patients could eat either a normal diet or soft food and five patients were discharged within 3-4 days. None of the serious sequelae usually associated with oesophageal perforation were observed, Two patients required second overlapping stents to be inserted within 1 week because of minor migration of the initial endoprostheses. In one patient two stents were necessary because the carcinoma extended over 17 cm, Five patients died after stent insertion (mean survival time = 49 days, range 16-80; median survival time = 37 days, range 16-80) due to a general deterioration in their condition, although ah could swallow normally until death, The remaining patient was well and tolerating a light diet at 1 month. Conclusion: This technique is quick, safe and cost-effective and is now our preferred method of managing malignant oesophageal obstruction associated with perforation.