Malignant oesophageal disease can be palliated by the siting of a plastic stent. However, this technique has now largely been superseded by thermal methods of recanalization, e.g. laser probes, and stents are now generally reserved for broncho-oesophageal fistula.
Stents cannot be placed in the proximal third of the oesophagus due to the risks of tracheal compression and asphyxia from stent movement proximally. Equally, siting in the distal third is avoided because of a tendency to blockage. Commercial tubes have proximal and distal flanges to reduce the risk of migration.
The tumour is first demarcated by radiography. It is then dilated up to size 54 French gauge and the stent is introduced by one of a variety of specialised introducers. Mortality from the procedure is high - up to 30% at 30 days.
Once the stent position has been recorded radiographically, a chest X-ray and water soluble barium swallow are performed within a few hours; this is to demonstrate perforation. In the absence of complications, the patient is restarted orally on solid food within 48 hours.
If the patient survives six months, a change of stent should be considered: the PVC type lose their flexibility with time and latex tubes disintegrate.
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