New Approach for Severe Cervical Stenosis with Polyflex Plastic Stents

摘要

IntroductionHypofaryngeal/cervical esophageal strictures and fistulas are a therapeutic challenge. Treatment for hypopharynx and cervical esophagus cancer (surgery and/or radiotherapy) are the main causes of these complications. Despite the fact that endoscopic dilation will solve most of the stricture cases and small fistulas will eventually heal, some patients will remain with severe stricture and large fistulas of difficult management. The use of metallic self-expandable stents in cervical stenosis or fistulas is somewhat limited due to severe cervical pain, globus sensation, bleeding, migration and patient intolerance. Recently, a plastic self expandable stents (polyflex) were designed for palliation of the esophageal neoplasm. Objective The objective of this study is to evaluate the safety and efficacy of the use of polyflex stents for cervical severe strictures and large fistula of difficult management (by endoscopy or surgery). Patients and Methods: We report our experience with 10 patients withhypopharyngeal/cervical esophageal strictures and/or fistulas treated with a poliflex stent positioned with endoscopy and fluoroscopy. There were 6 cases of larynx/hypopharynx cancer and 4 cases of esophageal cancer. The stents were used for 6 cases of stenosis and 4 cases of fistula. At the time of the procedure, 2 patients had a persistent tumor in the place of the polyflex and 8 had no evidence of disease. The polyflex stents were in place from a period varying from 21 to 145 days, 7 patients presented a good tolerance to the cervical stent; 1 case presented aspiration after stent placement, one patient present with moderate cervical pain, and one present bleeding from the tumor. 7 patients had a good to complete resolution of the fistula/stricture, returning to oral intake; 3 cases presented with stent-migration (20, 45 and 120 days after polyflex placement), in 2 of them a new stent wasrteplaced. DiscussionMetallic stents are usually not indicated for hypofaryngeal/cervical esophageal stricture and fistulas due to patient intolerance and complications. The plastic self expandable stents (polyflex) seems to be a good alternative for cases of hypofaryngeal/cervical esophageal severe stricture and large fistulas of difficult management with endoscopy and/or surgery. Patients' tolerance to the cervical stent is very reasonable and improvements of the stricture/fistula including the return to oral intake are the attractive for the use of this new device on selected cases.