Study patients

All patients with malignant dysphagia from either primary adenocarcinoma or squamous cell carcinoma (SCCA) of the esophagus were considered for enrollment. Patients with severe dysphagia and the following circumstances received sccSEMS: (I) patients unable to manage secretions without aspiration; (II) patients with incomplete response to neoadjuvant chemoradiation therapy awaiting surgery; (III) patients receiving chemotherapy with severe dysphagia not controlled by serial dilation; (IV) patients with terminal disease and severe dysphagia. Patients with dysphagia from external compression of the esophagus from non-esophageal cancer were excluded. Patients were enrolled over a 26-month period between January 1, 2008 and March 1, 2011. The clinical follow-up period extended to June 1, 2011.

After initial sccSEMS placement, patients returned at 6 to 8 week intervals for endoscopic surveillance. Endoscopy was also performed to investigate new symptoms and administer trans-stent therapies. Terminally ill hospice patients did not undergo surveillance endoscopy. Endoscopy was performed in asymptomatic patients when stent migration was noted incidentally on imaging studies. Patients were contacted by telephone within 24 to 48 hours after each endoscopy procedure and were also seen periodically in the Endosocpic Oncology Section’s outpatient clinics. Patients were followed until: (I) dysphagia resolved and stent therapy was no longer required as signified by anticipated stent migration; (II) death with stent in place; or (III) June 1, 2011.