The use of metallic stents in the palliation of inoperable oesophageal carcinoma.

Carcinoma of the oesophagus is the seventh most common malignancy worldwide. It is a disease with a poor prognosis; more than half of the patients present with surgically irresectable tumours. For such patients, palliative therapy is directed towards the relief of dysphagia. Expandable metallic stents have recently been developed for use in the oesophagus. These have the advantage of being introduced through small diameter delivery catheters. Once released, they can expand to as much as 25 mm in diameter, potentially allowing patients to consume a normal diet. The current designs of metallic stents include the Strecker stent, the Wallstent endoprosthesis, and the Gianturco-Rosch stent. The Strecker is an uncovered stent while the other two are covered on the outside of the stent with plastic to prevent tumour ingrowth. A review of the literature indicates that deployment of these stents is associated with a high technical success rate. Improvement in swallowing function is seen in 83% to 100% of these patients. The overall complication rates are low. However, covered stents are prone to migration while uncovered stents are vulnerable to tumour ingrowth. Further improvements in design promise to expand the role of these endoprostheses in the management of oesophageal carcinoma.