Purpose: The severe stenosis and complicated malignant esophagus and gastric outlet obstruction (GOO) is a difficult task for endoscopists. The purpose is analysis of SEMS placement of cancer obstruction of UGI.
Methods: During 2014 17, 53 cases of inoperable esophagus and GOO were analyzed. 41 cases (77.3 %) of stenosis caused by cancer of esophagus and EJ, 12 (22.7 %) patients had malignant GOO. The AC of esophagus and gastric was diagnosed in 39 (73.5%) cases, SCC of esophagus in 7 (13.2 %) patients and 7 (13.3 %) cases of advanced tumors of HPB system. In 2 (3.7 %) patients the stenosis was complicated by esophageal-bronchial fistula and esophageal-pleural fistula.
Results: 60 SEMS were implanted to 53 (100%) patients. The 2 stents were deployed for 7 (13.2%) patients and 1 stent to 46 (86.8%) patients. For esophageal cancer with fistula we deployed FCSEMS. 8 (15 %) patients with esophageal stenosis had diameter less than 5 mm that appear difficulties to hold delivery system through stenos. In these cases before stenting we perform aggressive dilation (33-39 Fr.). The technical success of all procedures 100 % and clinical regress of obstruction 95.3 %. Early complications were: bleeding in 2 (3.7%) patients and migration in 3 (5.6%) patients. Late outcomes were: migration 4 (7.5%), in growth 2 (3.7%), stent disruption 1 (1.8%), obstruction by food 1 (1.8%). 5 (9.4%) patients noted the heartburn. All complications were solved by endoscopic and drug therapy. No lethal outcomes was observed.
Conclusion: FCSEMS is effective for fistula formation and prevent in growth tissue. PCSEMS prevent migration. The using of bougie or balloon dilatation before stenting is necessary procedure in the case of severe stenosis. SEMS shows highly effective for palliation therapy.