Esophageal stents with antireflux valve for tumors of the distal esophagus and gastric cardia: a randomized trial.

Abstract

BACKGROUND:

Self-expandable metal stents deployed across the gastroesophageal junction predispose to gastroesophageal reflux. The efficacy of a stent with an antireflux mechanism in preventing gastroesophageal reflux was assessed.

METHODS:

Thirty patients with carcinoma of the distal esophagus or of the gastric cardia were randomized to receive either a stent with a windsock-type antireflux valve (FerX-Ella) (n = 15) or a standard open stent (n = 15) of the same design minus the valve. Gastroesophageal reflux was assessed by using standardized questionnaires and by 24-hour pH monitoring 14 days after treatment.

RESULTS:

Technical problems occurred during stent placement in 3 patients: migration (n = 2) and a problem with the introducing system (n = 1). Dysphagia improved from a median score of 3 (liquids only) to 1 (eat some solid food) in the antireflux group and from 3 to 0 (solid foods) in the open stent group ( p > 0.20). Reflux symptoms were reported by 3/12 patients (25%) with an antireflux stent and by 2/14 (14%) with an open stent. In 11 patients, 24-hour pH monitoring was obtained, and increased esophageal acid exposure (normal: <4%) was present with both types of stent: median 24-hour reflux time (9 patients) with the antireflux stent was 23% vs. 10% in (2 patients) with the open stent ( p = NS). Major complications occurred in 3 patients (20%) in each group and included bleeding (n = 3), severe pain (n = 2), and aspiration pneumonia (n = 1). The main cause of recurrent dysphagia was stent migration, which occurred in 7 of the 30 patients (23%).

CONCLUSIONS:

The FerX-Ella antireflux stent provided relief of dysphagia caused by malignancy of the distal esophagus and gastric cardia. However, the antireflux valve failed to prevent gastroesophageal reflux.

• Authors: Marjolein Y V Homs, Peter J Wahab, Ernst J Kuipers, Ewout W Steyerberg, Tim A Grool, Jelle Haringsma, Peter D Siersema
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 60 Issue 5 Pg. 695-702 (Nov 2004) ISSN: 0016-5107 [Print] United States
• PMID: 15557944 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial)

Topics

• Aged
• Cardia
• Deglutition Disorders (etiology, therapy)
• Esophageal Neoplasms (complications, therapy)
• Female
• Gastroesophageal Reflux (prevention & control)
• Humans
• Male
• Prosthesis Failure
• Recurrence
• Stents