Clinical outcomes of esophageal stents in patients with malignant esophageal obstruction according to palliative additional treatment. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Kim, Ji Yeon; Kim, Sang Gyun; Lim, Joo Hyun; Im, Jong Pil; Kim, Joo Sung; Jung, Hyun Chae
• Is Part Of: Journal of digestive diseases. Volume 16:Issue 10(2015:Oct.)
• Page Start: 575
• Page End: 584
• Publication Date: 2015-10
• Subjects: efficacy -- esophageal neoplasms -- malignant obstruction -- palliation -- self‐expanding metal stent; Digestive organs -- Diseases -- Periodicals; Gastroenterology -- Periodicals; 616.3
• DOI: 10.1111/1751-2980.12280
• Languages: English
• ISSNs: 1751-2972

Abstract

Abstract : Objective: To evaluate the efficacy and feasibility of esophageal self‐expanding metal stents (SEMS) insertion for malignant esophageal obstruction (MEO) in patients with or without additional palliative treatment. Methods: We retrospectively reviewed the medical records of the patients with SEMS for MEO. Baseline characteristics, changes in Mellow–Pinkas dysphagia score, and adverse events were collected and compared according to the presence and absence of additional palliative treatment. Results: Altogether 192 patients underwent 236 SEMS insertion procedures. Esophageal, gastric cardiac and lung cancers were seen in 46.4%, 33.3% and 15.1% of the patients, respectively. Their Mellow–Pinkas score significantly decreased within one week and one month after the SEMS insertion (1.66 ± 0.79 and 1.71 ± 0.87 vs 3.09 ± 0.79, respectively, P = 0.000). Complications occurred in 54 (22.9%) of 236 SEMS insertion; there were 28 (11.9%) stent obstruction, 5 (2.1%) perforation (2.1%), 10 (4.2%) stent migration, 5 (2.1%) tracheoesophageal fistula, but no procedure‐related death. Most complications were managed by inserting additional SEMS. The risk of stent obstruction was significantly higher in uncovered stents than in covered SEMS (OR 3.56, 95% CI 1.39–9.12, P = 0.006). Mean duration to the development of complications was 74.8 ± 111.1 days. Overall survival (169.0 ± 127.8 days vs 96.4 ± 90.6 days, P = 0.000) and stent patency (143.3 ± 123.9 days vs 67.6 ± 71.3 days, P = 0.000) were significantly favorable in patients with SEMS and additional palliative treatments compared with those with SEMS alone. Conclusion: SEMS insertion is effective and safe for treating MEO, and additional palliative treatment might lengthen stent patency by prolonging the patient's survival.