Double layered self-expanding metal stents for malignant esophageal obstruction, especially across the gastroesophageal junction.
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.
['Kim|Min Dae|MD|', 'Park|Su Bum|SB|', 'Kang|Dae Hwan|DH|', 'Lee|Jae Hyung|JH|', 'Choi|Cheol Woong|CW|', 'Kim|Hyung Wook|HW|', 'Chung|Chung Uk|CU|', 'Jeong|Young Il|YI|']
D000368:Aged D000369:Aged, 80 and over D004724:Endoscopy D004867:Equipment Design D004935:Esophageal Diseases D004940:Esophageal Stenosis D004942:Esophagitis, Peptic D004943:Esophagogastric Junction D005260:Female D005762:Gastroenterology D006801:Humans D008297:Male D008670:Metals D008875:Middle Aged D015607:Stents D016896:Treatment Outcome
Metal stent Malignant esophageal obstruction Gastroesophageal junction