BACKGROUND: Manufacturers recommend fluoroscopic guidance for placement of self-expanding metal stents (SEMS) in the esophagus AIM: Determine the feasibility and safety of SEMS placement with endoscopic guidance alone. METHOD: Prospective observational study of consecutive SEMS placement without fluoroscopy. Eleven consecutive patients with esophageal cancer had the following SEMS placed: Instent (C. R. Bard, Inc., Billerica MA) n = 7, Ultraflex (Microvasive, Watertown, MA); uncoated n = 2, coated n = 1, and Z-stent (Wilson-Cook, Winston-Salem, NC); n = 1. Fluoroscopy was used in 2 cases to confirm guidewire placement for dilation when the tumor could not be passed. Otherwise wires were placed with endoscopic guidance using pediatric scopes when necessary. Upper and lower edges of the tumor were measured endoscopically from the incisors and a distance was chosen for placement of the middle of the stent and marked on the delivery system. The system was positioned by distance and the endoscope was passed alongside to observe deployment. Proper system placement was confirmed by positioning the proximal end of stent at a predetermined distance from the incisors which accounted for any shortening of the stent and was monitored by endoscopy during deployment. RESULTS: All 11 SEMS were properly positioned after deployment. Nine patients were discharged home the same day and 2 the following day. All had relief of dysphagia at follow up in 1 week. Three required narcotics for increased chest pain which improved spontaneously. No perforation or bleeding or migration occurred. CONCLUSION: Fluoroscopy is not necessary for routine SEMS placement for malignant esophageal strictures.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging