A new fully covered stent with antimigration properties for the palliation of malignant dysphagia: a prospective cohort study

Uitdehaag, Madeleen; Siersema, Peter D.; Spaander, Manon; Vleggaar, Frank P.; Verschuur, Els; Steyerberg, Ewout W.; Kuipers, Ernst J.

doi:10.1016/j.gie.2009.09.023

Cited by 74 publications

(58 citation statements)

References 22 publications

(56 reference statements)

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“…The observed sccSEMS unanticipated per-stent and per-patient migration rates were comparable to those reported for large caliber fully covered SEMS (lccSEMS) placed for palliation purposes (22,23). The median effective duration for first sccSEMS placement was 116 days.…”

Section: Discussionsupporting

confidence: 66%

“…Median DSs typically decreased by two levels when lccSEMS were placed (22,23,(33)(34)(35). Median DSs in our sccSEMS patients decreased by only one level.…”

Section: Discussionmentioning

confidence: 51%

“…Major AEs (severe pain, hemorrhage, fever, and fistula) occurred in 20% of patients, minor AEs in 22%, and stent related deaths in 7%. Prospective studies of lccSEMS of different design from other manufactures have revealed similar AE rates (13,22,33). In the current 31 patient sccSEMS study, major AEs occurred in 6.5% of patients, minor AEs in 19.4%, and stent related deaths in no patients.…”

mentioning

confidence: 90%

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Small caliber covered self expanding metal stents in the management of malignant dysphagia.

Kucera

Shridhar

Klapman

et al. 2016

JCO

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Background: Use of large caliber [≥18 mm body diameter (BD)] self-expanding metal stents (SEMS) for management of malignant dysphasia is associated with substantial adverse event (AE) and mortality rates (MRs). We sought to determine dysphagia response, stent migration rates, and AE and MRs, for small caliber covered SEMS (sccSEMS) with BDs between 10-16 mm in malignant dysphagia. Results: DS improved in 30 of 31 patients (97%). The median DS decreased from 3 to 2 (P<0.0001). The median effective duration of first sccSEMS placement was 116 (95% CI: days. Major and minor AE rates were 6.5% and 19.4% respectively. No stent related deaths were encountered. The overall migration rate was 36% (18/50). The anticipated migration rate was 45.7% (16/35) and the unanticipated migration rate was 13.3% (2/15) (P=0.052). Positive effective clinical outcome occurred in 93.5% (29/31) of cases. Conclusions:In malignant dysphagia, direct endoscopic sccSEMS placement provided acceptable dysphagia control and migration rates with substantial reductions in stent related AEs and MRs compared to those reported for large caliber SEMS. The median dysphagia score (DS) improved to 1 in both groups of patients. However, the rigid stent group experienced 14% procedure related mortality, whereas, the SEMS group experienced no procedure related mortality. Similar complication and MRs were observed by others (5-7). Uncovered SEMS rapidly replaced rigid stents for management of malignant dysphagia (8). However, frequent tumor in-growth obstruction problems were encountered (7,(9)(10)(11). Covering the stent mesh reduced tumor in-growth, but increased SEMS migration rates (12)(13)(14). To address both the tumor in-growth problem and the migration problem, manufacturers pursued various design modifications to include covering only a portion of the SEMS body, increasing the SEMS BD, changing the shape of the SEMS body, or a combination of all three.A randomized controlled trial by Siersema et al. (15) of partially covered and covered SEMS designs from three different manufacturers suggested that SEMS with BDs >20 mm were less likely to migrate when placed across distal esophagus and cardia malignant strictures. However, major stent related complications (perforation, bleeding, fever, pressure necrosis, severe pain) occurred in 18% to 36% of patients and overall 30-day mortality was 15%. In the multicenter randomized Dutch SIREC trial (16), 18 and 23 mm BD partially covered SEMS were compared to brachytherapy as palliation for inoperable esophageal adenocarcinoma. SEMS migration occurred in 17% and tumor in-or over-growth occurred in 15% of patients randomized to treatment with the partially covered SEMS. Major stent related complications occurred in 25% of patients. Stent related mortality was 9%.The available data from existing studies suggests that the major complication and MRs for covered or partially covered SEMS with BDs ≥18 mm are similar to those produced by the non-expandable rigid legacy stents that SEMS were designed to replace. Upon...

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Section: Discussionsupporting

confidence: 66%

“…Median DSs typically decreased by two levels when lccSEMS were placed (22,23,(33)(34)(35). Median DSs in our sccSEMS patients decreased by only one level.…”

Section: Discussionmentioning

confidence: 51%

mentioning

confidence: 90%

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Small caliber covered self expanding metal stents in the management of malignant dysphagia.

Kucera

Shridhar

Klapman

et al. 2016

JCO

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“…The SX-ELLA stent esophageal HV stent (Ella-CS, Hradec Kralove, Czech Republic) was developed with a flip-flop ring at the proximal end but showed disappointing results and a 20% migration rate in a prospective study with malignant strictures [20]. When an internally covered metallic stent (ALIMAXX-E; Alveolus Inc., Charlotte, NC, USA) with external antimigration struts was used, the migration occurred in 34% to 36% of patients, showing a weak effectiveness [13,21,22].…”

Section: Discussionmentioning

confidence: 99%

The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study

et al. 2011

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“…The migration risk increase when the stent is placed across the gastroesophageal junction [22]. Partially covered SEMS help to prevent migration but their removal is sometimes difficult according to high rate of tumor in growth [18,31].…”

Section: Post Procedures Complicationsmentioning

confidence: 99%

Palliation of Neoplastic Esophageal Strictures with Metallic Stents

Nozari¹

2017

JCTR

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Abstract:Most patients with advanced esophageal neoplasm have dysphagia and suffer from cachexia and malnourishment.Supportive treatments focus on symptom palliation and improving quality of life at this time. Guidelines illustrated some indications for stent use in esophageal neoplasm such as inoperable neoplastic obstruction, presence of neoplastic fistula or perforation, tumor recurrence and contraindication for chemo-radiotherapy. Palliative stents help relieve dysphagia, manage mouth secretions, reduce aspiration risk, and maintain oral intake. Stent placement sometimes requires both endoscopic and fluoroscopic guidance. A stricture dilation is not necessary before stent placement. Success rate of SEMS placement was reported 80-100%. Complications of stents are bleeding, perforation, migration, and tumor ingrowth. Coated SEMS are the treatment of choice in the presence of neoplastic trachea-esophageal fistula. Partially covered stents are used for neoplastic stricture but their removal is sometimes difficult. The stent can be left in esophagus indefinitely for palliation in cases with progressive disease. In this article, we reviewed the recent literatures for efficacy of palliative metal stents placement in patients with esophageal neoplasm.

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A new fully covered stent with antimigration properties for the palliation of malignant dysphagia: a prospective cohort study

Cited by 74 publications

References 22 publications

Small caliber covered self expanding metal stents in the management of malignant dysphagia.

Small caliber covered self expanding metal stents in the management of malignant dysphagia.

The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study

Palliation of Neoplastic Esophageal Strictures with Metallic Stents

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