Placement of esophageal self-expanding metallic stents without fluoroscopy

Background. Fluoroscopy is routinely used to guide the placement of self-expanding metallic stents for the palliative treatment of patients with esophageal malignancy. This is a description of a novel method of stent placement without fluoroscopy. Methods: This technique relies on a clear endoscopic view of the proximal radiopaque marker on the stent. This was achieved by the application of an external white marker at this level. A gastroscope was passed, allowing guidewire deployment and measurement of stricture length. The endoscope was reinserted and placed alongside the guidewire giving direct visualization of the proximal margin of the stricture. The stent delivery device was positioned, keeping the white mark visible proximal to the stricture, and the stent was deployed. Results: Thirty consecutive patients with inoperable esophageal malignancy underwent endoscopic placement of self-expanding metal stents. Deployment in satisfactory position without fluoroscopy was successful in 23 of 30 (77%); there were no complications. Conclusions:The majority of esophageal stents can be accurately positioned without fluoroscopy.