Factors That Affect Stent-Related Complications in Patients with Malignant Obstruction of the Esophagus or Gastric Cardia

Abstract

Background/AimsSelf-expandable metallic stent (SEMS) placement is effective for dysphagia that results from malignant obstruction of the esophagus or gastric cardia; however, stent-related complications may be life-threatening. Thus, the goal of this study was to identify risk factors associated with complications following esophageal stenting.MethodsOf the 71 patients who underwent SEMS placement for dysphagia as a result of malignant stricture of the esophagus or gastric cardia, 53 patients with squamous cell carcinoma or adenocarcinoma, without previous SEMS placement, without a fistula, and without recurrent tumor after surgery were retrospectively identified. The occurrence of stent-related complications was used as an endpoint.ResultsStent-related complications were identified in 26 patients (49.1%), and major complications occurred in 14 patients (26.4%). The use of an Ultraflex stent (odds ratio [OR], 6.81; 95% confidence interval [CI], 1.54 to 30.00; p=0.011) and prior chemotherapy (OR, 6.13; 95% CI, 1.46 to 25.70; p=0.013) were significantly associated with stent-related complications. Moreover, the use of an Ultraflex stent (OR, 19.60; 95% CI, 2.26 to 170.00; p=0.007) and prior radiation (OR, 25.70; 95% CI, 2.37 to 280.00; p=0.008) significantly increased the risk of major complications.ConclusionsThe use of an Ultraflex stent and prior radiation and/or chemotherapy may represent risk factors for complications following esophageal SEMS placement.

Investigation of Factors Affecting Clinical Outcomes after Stent Placement in Malignant Obstruction of the Esophagus or the Gastric Cardia

“…Indeed, the risk of recurrent dysphagia after SEMS placement should be also considered as important clinical outcome. In the report of Iwasaki et al .,10 recurrent dysphagia resulting from tumor overgrowth, tumor ingrowth, stent migration, or food bolus impaction occurred in 12 patients (22.6%). So, it would be interesting to define the recurrent dysphagia as primary outcome and to perform same analysis to find factors affecting the recurrent dysphagia.…”

“…So, it would be interesting to define the recurrent dysphagia as primary outcome and to perform same analysis to find factors affecting the recurrent dysphagia. The lack of these analyses might be the limitation of study by Iwasaki et al 10. Nevertheless, their report should provide clinicians with helpful information for prediction of complications after SEMS placement in malignant obstruction of the esophagus or gastric cardia.…”

“…In this issue of Gut and Liver , Iwasaki et al 10. have attempted a comprehensive approach to investigate the factors affecting stent-related complications in patients with carcinoma of the esophagus or gastric cardia.…”

“…In case of SEMS placement bridging the gastroesophageal junction, by contrast, development of gastroesophageal reflux which results in severe ulcerative esophagitis with hemorrhage as well as aspiration pneumonia, and occurrence of stent migration into the stomach which results in recurrent dysphagia or even bowel obstruction have been serious clinical concerns 9. In the report of Iwasaki et al .,10 location of tumor was upper or middle esophagus in about 58% of patients, whereas, in 42% of patients, tumor was located in lower esophagus or gastroesophageal junction. Therefore, it would be needed to perform a subgroup analysis according to the tumor location.…”

ESOPHAGEAL STENTING FOR MALIGNANT STENOSIS (three-year outcomes)

“…Отличительными особенностями данного лечебного пособия являются его малая инвазивность и непосредственное достижение желаемого результата. Однако публикации последнего времени [1][2][3][4] свидетельствуют о том, что длительное нахождение стента в пищеводе приводит к развитию большого числа различных осложнений, достигающего, по некоторым данным, 75,0 %. Наиболее значимыми из них являются перфорация опухоли при установке стента (до 7,5 %), кровотечение (1-12 %), миграция стента (5-9,8 %), образование свищей (1,,0 %) [5][6][7][8].…”