New Design Esophageal Stents for the Palliation of Dysphagia From Esophageal or Gastric Cardia Cancer: A Randomized Trial

Verschuur, Els; Repici, Alessandro; Kuipers, Ernst J.; Steyerberg, Ewout W.; Siersema, Peter D.

doi:10.1111/j.1572-0241.2007.01542.x

Cited by 173 publications

(181 citation statements)

References 18 publications

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“…The Niti-S stent (Taewoong Medical Inc, Seoul, Korea) was designed with flares to 26 mm at both ends and a double-layer configuration comprising an inner polyurethane layer to prevent tumor ingrowth and an outer uncovered nitinol-wire tube to allow the mesh of the stent to embed itself in the esophageal wall [30]. In a recent randomized prospective trial, recurrent dysphagia due to stent migration was less frequently seen with the Niti-S stent (12%) than with the Ultraflex (17%) or Polyflex (29%) stent [31]. We prefer to use the Ultraflex stent with a diameter of 18/23 mm, which, similar to other stents [21,32], is available with uncovered proximal and distal segments, allowing the normal mucosa above and below the tumor to project into the stent lumen.…”

Section: Discussionmentioning

confidence: 98%

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

et al. 2010

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Section: Discussionmentioning

confidence: 98%

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

et al. 2010

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“…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: 98%

“…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.…”

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confidence: 99%

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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“…Diese leichte Entfernbarkeit wird mit einer hohen Migrationsrate «erkauft» (etwa 25%) [65]. In 2 prospektiven, randomisierten Studien [66,67], bei denen der Polyflexstent mit dem Ultraflexstent verglichen wurde, konnte zwar eine etwa gleich gute Reduktion der Dysphagie erzielt werden, aber die Komplikationsrate des Polyflexstents von bis zu knapp 50% war in beiden Studien signifikant höher als die des Ultraflexstents. Hauptkomplikation war die Stentmigration.…”

Section: Selbstexpandierende Plastikstentsunclassified

Palliative Therapie des Ösophaguskarzinoms

May¹

2008

Chir Gastroenterol

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Palliative Treatment of Esophageal Cancer. The aim of the palliative treatment is to reduce dysphagia and to maintain oral food intake and improve quality of life. The palliative therapy is divided into the nonendos copic and endoscopic treatment modalities. The non-endoscopic therapies include chemotherapy and external beam or intraluminal radiotherapy (brachytherapy). Because of the poor condition and/or the advanced cancer stage minimal invasive endoscopic therapies are the first choice in most patients. Nowadays a variety of treatment modalities such as bougienage and dilation as well as thermal destruction using laser or argon plasma coagulation devices and self-expanding metal stents are available. Often bougienage, thermal destruction, and stents are combined. Thermal destruction devices are mainly used for therapy of soft, exophytic and short tumors. The main disadvantage of these procedures is the need for repeated therapy sessions at regular intervals. In case of very rigid and long tumor stenoses and/or submucosal tumors self-expanding metal stents leading to a safe and effective palliation should be preferred.

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New Design Esophageal Stents for the Palliation of Dysphagia From Esophageal or Gastric Cardia Cancer: A Randomized Trial

Cited by 173 publications

References 18 publications

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

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

Palliative Therapie des Ösophaguskarzinoms

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New Design Esophageal Stents for the Palliation of Dysphagia From Esophageal or Gastric Cardia Cancer: A Randomized Trial

Cited by 173 publications

References 18 publications

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

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

Palliative Therapie des &Ouml;sophaguskarzinoms

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Palliative Therapie des Ösophaguskarzinoms