Effect of stent size on complications and recurrent dysphagia in patients with esophageal or gastric cardia cancer.

Abstract

BACKGROUND:

Stents are commonly used for the palliation of dysphagia from esophageal or gastric cardia cancer. A major drawback of stents is the occurrence of recurrent dysphagia. Large-diameter stents were introduced for the prevention of migration but may be associated with more complications.

OBJECTIVE:

To compare small- and large-diameter stents for improvement of dysphagia, complications, and recurrent dysphagia.

DESIGN:

Evaluation of 338 prospectively followed patients with dysphagia from obstructing esophageal or gastric cardia cancer who were treated with an Ultraflex stent (n = 153), a Gianturco Z-stent (n = 89), or a Flamingo Wallstent (n = 96) of either a small diameter (n = 265) or a large diameter (n = 73) during the period 1996 to 2004.

SETTING:

Single academic center.

PATIENTS:

Patients with an inoperable malignant obstruction of the esophagus or the gastric cardia, or recurrent dysphagia after prior radiation, with curative or palliative intent for esophageal cancer.

INTERVENTIONS:

Stent placement.

MAIN OUTCOME MEASUREMENTS:

Dysphagia score (on a scale from 0 [no dysphagia] to 4 [complete dysphagia]), complications, and recurrent dysphagia. Analysis was by chi2 test, log-rank test, and Cox regression analysis.

RESULTS:

Improvement in dysphagia was similar between patients with a small- or a large-diameter stent (P = .35). The occurrence of major complications, such as hemorrhage, perforation, fistula, and fever, was increased in patients with a large-diameter Gianturco Z-stent compared with those treated with a small-diameter stent (4 [40%] vs 16 [20%]; adjusted hazard ratio [HR] 5.03, 95% confidence interval [CI] 1.33-19.11) but not in patients with a large-diameter Ultraflex stent or a Flamingo Wallstent. Moreover, minor complications, particularly pain, were associated with prior radiation and/or chemotherapy in patients with a large- or a small-diameter Gianturco Z-stent (HR 4.27, 95% CI 1.44-12.71) but not in those with an Ultraflex stent or a Flamingo Wallstent. Dysphagia from stent migration, tissue overgrowth, and food bolus obstruction reoccurred more frequently in patients with a small-diameter stent than in those with a large-diameter stent (Ultraflex stent: 54 [42%] vs 3 [13%], adjusted HR 0.16, 95% CI 0.04-0.74; Gianturco Z-stent: 21 [27%] vs 1 [10%], adjusted HR 0.97, 95% CI 0.11-8.67; and Flamingo Wallstent: 21 [37%] vs 6 [15%], adjusted HR 0.40, 95% CI 0.03-4.79).

LIMITATIONS:

Nonrandomized study design.

CONCLUSIONS:

Large-diameter stents reduce the risk of recurrent dysphagia from stent migration, tissue overgrowth, or food obstruction. Increasing the diameter in some stent types may, however, increase the risk of stent-related complications to the esophagus.

• Authors: Els M L Verschuur, Ewout W Steyerberg, Ernst J Kuipers, Peter D Siersema
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 65 Issue 4 Pg. 592-601 (Apr 2007) ISSN: 0016-5107 [Print] United States
• PMID: 17383456 (Publication Type: Comparative Study, Journal Article)

Topics

• Aged
• Cardia
• Deglutition Disorders (etiology, prevention & control, surgery)
• Endoscopy, Gastrointestinal (methods)
• Equipment Design
• Esophageal Neoplasms (complications)
• Female
• Humans
• Male
• Middle Aged
• Postoperative Complications
• Prospective Studies
• Secondary Prevention
• Stents (adverse effects)
• Stomach Neoplasms (complications)
• Treatment Outcome