Placement of PEG tubes through previously placed self-expanding esophageal metal stents.

BACKGROUND Self-expanding metal stents are frequently used to palliate patients with malignant dysphagia and close tracheoesophageal fistulae. Despite proper stent positioning and deployment, in a subset of patients there is no improvement in dysphagia, closure of tracheoesophageal fistulae, or resolution of anorexia. Such patients may require a PEG tube. It has been suggested that PEG placement through a preexisting esophageal stent is problematic because of the risks of gastrostomy tube impaction within the stent and resultant stent migration. METHODS Case records were retrospectively reviewed of 9 consecutive patients with indwelling esophageal self-expanding metal stents undergoing attempted PEG. OBSERVATIONS PEG tube placement was successful in all patients. In 1 patient, the stent migrated distally into the stomach during PEG placement. This was managed endoscopically without further complication. CONCLUSIONS PEG placement in patients with previously placed esophageal self-expanding metal stents is a relatively safe and feasible procedure, although stent migration may occur.

[1]  N. Vakil,et al.  Human tissue responses to metal stents. , 1999, Gastrointestinal endoscopy clinics of North America.

[2]  D. Wengrower,et al.  EsophaCoil: long-term results in 81 patients. , 1998, Gastrointestinal endoscopy.

[3]  P. Rutgeerts,et al.  A comparison of laser therapy, plastic stents, and expandable metal stents for palliation of malignant dysphagia in patients without a fistula. , 1998, Gastrointestinal endoscopy.

[4]  A. May,et al.  Palliative treatment of malignant esophagorespiratory fistulas with Gianturco-Z stents. A prospective clinical trial and review of the literature on covered metal stents. , 1998 .

[5]  I. Raijman.  ENDOSCOPIC MANAGEMENT OF ESOPHAGORESPIRATORY FISTULAS: EXPANDING OUR OPTIONS WITH EXPANDABLE STENTS , 1998, American Journal of Gastroenterology.

[6]  W. Hop,et al.  Coated self-expanding metal stents versus latex prostheses for esophagogastric cancer with special reference to prior radiation and chemotherapy: a controlled, prospective study. , 1998, Gastrointestinal endoscopy.

[7]  Gupta Rc,et al.  Placement of a percutaneous gastrostomy tube in patients with an existing esophageal prosthesis. , 1997 .

[8]  Z. Fan,et al.  Expandable thermal-shaped memory metal esophageal stent: experiences with a new nitinol stent in 129 patients. , 1997, Gastrointestinal endoscopy.

[9]  R. Gaskins,et al.  Utilization of an esophageal stent for subsequent placement of a percutaneous endoscopic gastrostomy tube. , 1997, American Journal of Gastroenterology.

[10]  R. Kozarek,et al.  Silicone-covered Wallstent prototypes for palliation of malignant esophageal obstruction and digestive-respiratory fistulas. , 1997, Gastrointestinal endoscopy.

[11]  N. Vakil,et al.  Human tissue responses to metal stents implanted in vivo for the palliation of malignant stenoses. , 1996, Gastrointestinal endoscopy.

[12]  G. D. De Palma,et al.  Plastic prosthesis versus expandable metal stents for palliation of inoperable esophageal thoracic carcinoma: a controlled prospective study. , 1996, Gastrointestinal endoscopy.

[13]  D. Fleischer.  Stents, clogology, and esophageal cancer , 1996 .

[14]  F. Keller,et al.  Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy. , 1995, Gastrointestinal endoscopy.

[15]  N. Vakil,et al.  A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. , 1993, The New England journal of medicine.