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Novel Approach to Endoscopic Placement of Esophageal Alimaxx Stents without Using Fluoroscopic Guidance

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Grosman, Igor DO*; Feldstein, Richard MD; Stark, Bernard MD; Kaushik, Neeraj MD

American Journal of Gastroenterology: September 2008 - Volume 103 - Issue - p S2
Supplement Abstracts Submitted for the 73rd Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Gastroenterology, North Shore University Hospital Manhasset, Manhasset, NY.

Purpose: Self Expandable Metal Stents (SEMS) are used increasingly as a non-surgical alternative for the palliation of malignant and treatment of benign gastrointestinal obstruction. Standard deployment techniques use endoscopic and fluoroscopic guidance. Some patients with post operative esophageal leak or tracheo-esophageal fistula are clinically unstable precluding transportation to radiology unit for fluoroscopy. Patients with esophageal cancer frequently undergo endoscopic ultrasound (EUS) for staging. If patient has unresectable disease a second endosccopy with fluoroscopy is usually performed for palliation increasing the procedure risks and cost. We report our experience of deploying SEMS with endoscopic guidance without the use of fluoroscopy for various indications. The ALIMAXX stent was chosen because of its convenient delivery system with a small diameter of that allows simultaneous endoscopic visualization during deployment.

Methods: We performed a retrospective review of all esophageal stent cases over 16 months (1/07–4/08). 9 patients were identified where ALIMAXX-E stent was deployed using only endoscopic guidance

Results: Nine patients (4 females and 5 males). The indication for stent placement were benign esophageal strictures (N = 1), malignant esophageal strictures (N = 5), tracheo-esophageal fistula (N = 1), esophageal perforation (N = 1), esophageal hemangioma with massive bleeding (N = 1). Endoscopic Ultrasound was done in 3 out of 5 malignant strictures in the same session as stent placement. 3 of the procedures were performed in ICU setting, 6 were done in endoscopy unit. Stent deployment was technically successful in all 9 patients (100%). Stent migration occured within 7 days in one patient with TE fistula requiring repeat stent deployment, and after 150 days in a malignant stricture secondary to shrinkage of tumor after radiation therapy. All patients reported improvement in dysphagia scores. Both esophageal perforation and TE fistula achieved successful closure. Gastrointestinal bleeding due to esophageal hemangioma successfully stopped after stent placement.

Conclusion: The ALIMAXX stent can be successfully deployed using endosopic guidance only without the aid of fluoroscopy. This is potentially useful when transportation of unstable patient to radiology units is not feasible and in decreasing number of invasive procedures and cost in the setting of EUS that shows non-resectable esophageal cancer. This appears to be a promising approach for esophageal stent deployment in selected indications.

© The American College of Gastroenterology 2008. All Rights Reserved.