Atila EROĞLU, Atila TÜRKYILMAZ, Yener AYDIN, Bayram ALTUNTAŞ

Treatment of complications caused by metallic stent placement in esophageal cancer

Amaç: Bu çalışmada özofagus kanserli hastalarda uygulanan, kendi kendine genişleyen metal stentlere bağlı gelişen komplikasyonlar ve bu komplikasyonların tedavi yöntemleri sunuldu.Ça lış ma pla nı: Çalışmaya kliniğimizde Ocak 2000 Aralık 2014 tarihleri arasında 334 metal stent yerleştirilen 268 ameliyat edilemez özofagus kanserli hasta (140 erkek, 128 kadın; ort. yaş 64.4±16.3 yıl; dağılım 28-91 yıl) dahil edildi. Komplikasyon gelişen hastalar ve bu komplikasyonlar için benimsenen tedavi yaklaşımları retrospektif olarak değerlendirildi.Bul gu lar: Toplam 365 komplikasyon görüldü. Otuz hastada majör komplikasyon [13 kanama (%4.8), 9 aspirasyon pnömonisi (%3.4), 3 trakeal kompresyon (%1.1), 2 perforasyon (%0.7) ve 3 özofagorespiratuvar fistül (%1.1)], 334 hastada minör komplikasyon [245 göğüs ağrısı (%91.4), 36 tümörün aşırı büyümesi (%13.4), bir tümörün içe doğru büyümesi (%0.4), 10 kısmi stent migrasyonu (%3.7), 8 stentin mideye düşmesi (%2.9), 12 gastroözofageal reflü (%4.5), 8 stentin yerleştirilememesi (%2.9), 5 hıçkırık (%1.9), 2 yabancı cisim hissi (%0.7), 2 stentin genişlememesi (%0.7), 1 granülasyon dokusu gelişimi (%0.4), 3 stentin gıda ile tıkanması (%1.1), 1 cilt erozyonu (%0.4)ve 1 stent kırılması (%0.4)] tespit edildi. Stent uygulaması öncesi ve sonrasında ortalama disfaji skoru sırasıyla 3.6 ve 2.4 idi. Stent uygulaması sonrası dört hastada (%1.5) mortalite gözlendi.So nuç: Özofageal stent uygulaması güvenli ve etkili bir yöntem olmasına rağmen birçok komplikasyona neden olmaktadır. Bu komplikasyonların nasıl tedavi edileceğini bilmek hastanın yaşam kalitesini artırıp morbidite ve mortaliteyi azaltabilir.

Özofagus kanserinde metal stent uygulamasının neden olduğu komplikasyonların tedavisi

Background: This study aims to present the complications arising from self-expanding metallic stents placed in patients with esophageal cancer and the treatment methods for these complications.Methods: The study included 268 patients with inoperable esophageal cancer (140 males, 128 females; mean age 64.4±16.3 years; range 28 to 91 years) who were placed 334 metallic stents in our clinic between January 2000 and December 2014. Patients who developed complications and treatment approaches adopted for these complications were evaluated retrospectively.Results: Totally, we observed 365 complications. We detected major complications in 30 patients [13 hemorrhages (4.8%), 9 aspiration pneumonias (3.4%), 3 tracheal compressions (1.1%), 2 perforations (0.7%), and 3 esophagorespiratory fistulas (1.1%)] and minor complications in 334 patients [245 chest pains (91.4%), 36 tumor overgrowths (13.4%), 1 tumor ingrowth (0.4%), 10 partial stent migrations (3.7%), 8 falling of stents into the stomach (2.9%), 12 gastroesophageal refluxes (4.5%), 8 stent placement failures (2.9%), 5 hiccups (1.9%), 2 foreign body sensations (0.7%), 2 stent expansion failures (0.7%), 1 granulation tissue formation (0.4%), 3 food bolus obstructions (1.1%), 1 skin erosion (0.4%), and 1 stent fracture (0.4%)]. Before and after stent placement, mean dysphagia scores were 3.6 and 2.4, respectively. Mortality was observed in four patients (1.5%) after stent placement.Conclusion: Although esophageal stent placement is a safe and effective method, it leads to many complications. Knowing how to treat these complications may increase patient's quality of life and decrease morbidity and mortality.

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