Expandable stents compared to conventional plastic endoprostheses in malignant oesophageal obstruction, especially in cardiac cancer and fistulas: the experience of the Netherlands Cancer Institute.

Abstract

BACKGROUND:

Advanced oesophageal carcinoma usually causes debilitating dysphagia. An endoprosthesis can offer adequate palliation. The self-expandable metal stents provide several advantages over the plastic endoprostheses: less traumatic introduction and stronger attachment to the oesophageal wall.

OBJECTIVE:

To evaluate whether the self-expandable stents are more effective, especially in the technically challenging group of patients with a cardiac carcinoma or a fistula.

SETTING:

A single-institution study (cancer hospital).

METHODS:

A retrospective study of 132 consecutive patients (92 men and 40 women; median age 67 years) in whom a stent was inserted between 1991 and 1996. A plastic stent was applied in 72 patients, and from 1994 onwards an expandable stent in 60 subsequent patients.

RESULTS:

Overall technical success rate was high for both types of stents: 93 vs 88%. Clear improvement of dysphagia occurred more often with the expandable stents (80%) compared to the plastic stents (62%). Unfortunately, loss of appetite remained a problem in 30% of the patients. In the more troublesome subgroup of cardiac carcinoma (n = 55) and (imminent) fistula (n = 42) stenting was equally effective. Early complications were significantly less often encountered for the self-expandables: 3 vs 45%, the same was true for insertion related mortality: 0 vs 10%. Also the need for reintervention was less frequent: 12 vs 23%. This was especially on the account of the plastic stent in fistulas.

CONCLUSIONS:

Technical success rate was excellent for all types of stents, but in particular for the self-expandable stents which were also associated with fewer side effects. The subgroups of fistula and cardia carcinoma did equally well, probably related to adequate choice of stent.

• Authors: B G Taal, W M Kooyman, H Boot
• Journal: European journal of gastroenterology & hepatology (Eur J Gastroenterol Hepatol) Vol. 10 Issue 9 Pg. 745-52 (Sep 1998) ISSN: 0954-691X [Print] England
• PMID: 9831268 (Publication Type: Comparative Study, Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Deglutition Disorders (etiology, therapy)
• Esophageal Fistula (complications, mortality)
• Esophageal Stenosis (complications, mortality, therapy)
• Female
• Heart Neoplasms (complications, mortality)
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Stents
• Survival Rate
• Treatment Outcome