Esophageal Stents:

Findings on
Esophagography in
46 Patient
PEMBIMBING :
Dr. NOVITA ELYANA, Sp.Rad

 Bagian servikal:
1. Panjang 5-6 cm,
setinggi vertebra
cervicalis VI sampai
vertebrathoracalis I
2. Anterior melekat
dengan trachea
3. Anterolateral tertutup
oleh kelenjar tiroid
4. Sisi dextra/sinistra
dipersarafi oleh nervus
recurren laryngeus
5. Posterior berbatasan
dengan hipofaring
6. Pada bagian lateral ada
carotid sheath beserta
isinya

Bagian torakal:
1. Panjang 16-18 cm, setinggi
vertebra torakalis II-IX
2. Berada di mediastinum superior
antara trakea dan kolumna
vertebralis
3. Dalam rongga toraks disilang
oleh arcus aorta setinggi
vertebratorakalis IV
dan bronkus utama sinistra
setinggi vertebra torakalisV
4. Arteri pulmonalis dextra
menyilang di bawah bifurcatio
trachealis
5. Pada bagian distal antara
dinding posterior esofagus dan
ventralcorpus
vertebralis terdapat ductus
thoracicus, vena azygos, arteri dan
vena
intercostali

Bagian abdominal:
1. Terdapat pars
diaphragmatica sepanjang 1
- 1,5 cm, setinggi
vertebratorakalis X sampai
vertebra lumbalis III
2. Terdapat pars abdominalis
sepanjang 2 - 3 cm,
bergabung dengan cardia
gaster disebut
gastroesophageal junction

PEMBIMBING :
Dr. NOVITA ELYANA, Sp.Rad

 OBJECTIVE. The purpose of this report is to assess

the findings on esophagography in pa- tients with
esophageal stents for palliation of malignant tumors
involving the esophagus.
CONCLUSION. Radiologists should be familiar with
findings of little importance (stent narrowing, flow of
contrast medium around stent, stent kinks, and
apparent esophageal narrow- ing below stent because
of incompletely distended hiatal hernias) versus more
important find- ings (polypoid defects above or below
stent, narrowing within or below stent, delayed stent
emptying, esophageal-airway fistulas, stent
migration, and abutting of distal stent against greater
curvature of stomach) on esophagography after stent
placement to guide endoscopists regarding the need
for stent revision.

MATERIAL
AND
METHODE

A review of our computerized radiology database

revealed 116 esophagrams after stent placement for
inoperable esophageal cancer or other malignant tumors involving the esophagus from 1996 to 2003.
These 46 patients comprised our study group. Fortyfour patients had esophagrams within 3 days of stent
placement (mean interval, 1 day) to EVuate
positioning of the stent and to exclude perforation.
Two patients had their initial esophagrams and eight
patients had a total of 13 follow-up esophagrams 1
13 months after stent placement (mean interval, 2
months). These 15 esophagrams were obtained
because of dysphagia (n = 13) or suspected
esophageal-airway fistulas (n = 2).

 When esophagrams were obtained immedi- ately

after stent placement, the patients initially were given
a water-soluble contrast agent (diatri- zoate
meglumine and diatrizoate sodium [Gastro- view,
Mallinckrodt]). If spot images showed a leak into the
mediastinum, the study was terminated. If spot
images did not show a leak, however, the pa- tient
was given a 250% weight/volume barium suspension
(E-Z-HD, E-Z-EM, Inc.), and addi- tional images were
obtained. The studies were performed by residents,
fellows, or attending gas- trointestinal radiologists,
and all were interpreted by the attending radiologists.
The stents had a mean length of 11 cm (range, 415
cm).

 placement and the clinical findings and course.

Seventeen patients (37%) had follow-up endoscopy
after esophagogra- phy; the endoscopic and
pathology reports were re- viewed and correlated with
the radiographic findings in these patients.

RESULTS :
Radiographic Findings of Little Clinical
Importance

PEMBIMBING :
Dr. NOVITA ELYANA, Sp.Rad

Narrowing
of stent
calibers

Seventeen (29%) of the 59 esophagrams revealed

tapered narrowing (less than 50% of the diameter of
the stent) in the midportion of the stent (Fig. 1). All
but two patients had relief from dysphagia, so this
waist characteristic was not thought to be
important.

Flow of
contrast
material
around the
sides of the
stent

16 esophagrams (27%) revealed flow of contrast

material around one (n=11) or both (n=5) sides of the
stent (Fig.2). In 15 of these patients, this finding was
not thought to be important because their dysphagia
resolved without further intervention. In the other
patient, contrast material passed around the stent
into a tracheoesophageal fistula.

Stent kinks

3 esophagrams (5%) revealed kinking or angulation

of the stent (Fig. 3). This finding was not thought to
be important because these patients all had
symptomatic improvement without further
intervention.

Incomplete
distention
of hiatal
hernia
mimicking
narrowed
distal
esophagus

Two esophagrams (3%) revealed apparent

narrowing of the distal esophagus just below the stent
because of a partially collapsed hiatal hernia with
barium trapped in the folds of the hernia (Fig. 4). In
both of these patients, endoscopy confirmed a hiatal
hernia

RESULTS :
Radiographic Findings of Little Clinical
Importance

PEMBIMBING :
Dr. NOVITA ELYANA, Sp.Rad

Defects
above stent

Two (3%) of the 59 esophagrams revealed polypoid

defects (1 cm and 0.7 cm) in the esophagus abutting
the proximal end of the stents. Both patients had
overgrowth of tumor into the proximal end of the
stent at endoscopy, so additional stents were placed.

Defects
below stent

Two esophagrams (3%) revealed polypoid defects (2

and 3 cm) in the esophagus abutting the distal end of
the stents. One patient had overgrowth of tumor into
the distal end of the stent (Fig. 5), and the other had
exuberant reactive fibrosis at endoscopy.

Narrowing
of lumen
within stent

Fourteen esophagrams (24%) revealed esophageal

narrowing within the distal end of the stent because
of tumor (n = 3), debris or blood clot (n = 3),
epithelial hyperplasia (n = 3), and unknown causes (n
= 5). The narrowed segment had an irregular contour
and abrupt distal margins in patients with tumor
ingrowth (Fig. 6) and a smooth contour and more
gradual margins in the patients with epithelial
hyperplasia (Fig. 7).

 Narrowing of lumen abutting distal end of stent

Fourteen esophagrams (24%) revealed esophageal
narrowing abutting the distal end of the stent
because of tumor overgrowth (n=3), tumor ingrowth
(n=2), debris or blood clot (n=3), epithelial
hyperplasia (n=2), and unknown causes (n=4). The
narrowed segment had an irregular contour with
abrupt margins in both patients with tumor ingrowth
and a smooth contour with tapered margins in both
patients with epithelial hyperplasia.
Delayed emptying of stentThree esophagrams
(5%) revealed delayed emptying of contrast material
from the stent because of recurrent tumor in two
patients and blood clot in one.

Esophagealairway
fistulas

Four esophagrams (7%) revealed contrast material

entering fistulas (two tracheoesophageal and two
esophagobronchial fistulas). The stents had all been
placed for palliation of known fistulas. In two patients,
the stents failed to protect the fistulas because their
distal ends were improperly positioned above the
fistulas. In the remaining two patients, the stents
were properly positioned, but barium passed around
the stent into the fistula in one and through the
uncovered distal end of the stent into a new fistula in
the other (Fig. 8). In two patients, additional stents
were placed.

Stent
migration

One esophagram (2%) revealed that a stent placed

across the gastroesophageal junction for palliation of
a carcinoma of the cardia had migrated into the
stomach (Fig. 9A). A new stent was therefore placed
(Fig. 9B).

 Stent Fractures
None of the 59 esophagrams revealed stent fractures
after stent placement.
Perforation
None of the 59 esophagrams revealed esophageal
perforations after stent placement.