Placement of Polyflex stents in patients with locally advanced esophageal cancer is safe and improves dysphagia during neoadjuvant therapy

Background Patients with locally advanced esophageal cancer who require neoadjuvant therapy have significant dysphagia. Objectives To prospectively evaluate Polyflex stents to treat malignant dysphagia and to ameliorate weight loss in patients with locally advanced esophageal cancer who will undergo neoadjuvant therapy. Design A prospective nonrandomized study. Setting Tertiary-referral cancer center. Patients Thirteen patients with esophageal cancer (11 adenocarcinoma, 2 squamous-cell carcinoma). All patients were men, with a mean age of 63 years. Interventions EUS followed by stent placement. Main Outcome Measurements Dysphagia scores and patient weights. Results There were no perforations and no episodes of bleeding. Immediate complications included chest discomfort in 12 of 13 patients. The mean dysphagia score at the time of stent placement was 3. Mean dysphagia scores obtained at 1, 2, 3, and 4 weeks after stent placement were 1.1 ( P = .005), 0.8 ( P = .01), 0.9 ( P = .02), and 1.0 ( P = .008), respectively. Stent migration occurred at some point in 6 of 13 patients (46%). Limitations A single center and small size of study. Conclusions Simultaneous EUS staging and Polyflex stent placement is safe and allows oral feeding during neoadjuvant therapy. Dysphagia scores improved in a statistically significant manner. Stent migration was a common event, although not all patients with a migrated stent will require stent replacement, because migration may be a sign of tumor response to neoadjuvant therapy.