Palliation of patients with esophagogastric neoplasms by insertion of a covered expandable modified Gianturco-Z endoprosthesis: experiences in 153 patients

Bartelsman, J. F. W. M.; Bruno, Marco J.; Jensema, Anigje J.; Haringsma, Jelle; Reeders, Jacques W. A. J.; Tytgat, G. N. J.

doi:10.1016/s0016-5107(00)70407-x

Cited by 120 publications

(74 citation statements)

References 21 publications

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“…The effect of dilation or ELT is relatively short and the treatment must be repeated frequently in many patients. Metallic stent wire could attach closely to the esophageal wall, making it difficult to slip down, and minor damage to tissue might occur around it [4] . Coated stents could seal fistulae immediately after insertion, control pulmonary infection of patients and improve their general conditions.…”

Section: Discussionmentioning

confidence: 99%

Clinical application of metallic stents in treatment of esophageal carcinoma

Yang¹

2004

WJG

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AIM:To evaluate the effects of self-expanding metal stents (SEMS) in patients with malignant esophageal obstruction and to analyze their prognosis and complications. METHODS:Seventy-four metallic stents were placed under fluoroscopic guidance in 66 patients with esophageal obstruction secondary to carcinoma, of whom, 6 cases were complicated by fistula. RESULTS:After seventy-two stents were successfully used in 66 cases without any severe complications (technical successful rate was 97%), the dysphagia score improved from 3.3±0.6 to 0.8±0.5 (P<0.01), and life quality improved significantly in all these patients. All fistulae were sealed immediately after coated stents were inserted in the six patients. New stents were placed in two patients: the stent migrated more than 2 cm, in one patient and the stent slipped into stomach in the other. Minor bleeding was found only in 28 patients during the operation. Reobstruction was found in 12 patients, but was successfully cured under endoscopy. The survival rate was 78%, 57% and 11% for 6 mo, 1 year and 2 years respectively. CONCLUSION:Placement of SEMS is a simple, safe, quick and efficient surgical method for treating esophageal carcinoma obstruction. It may be used mainly as a palliative treatment of esophageal obstruction secondary to carcinoma.

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Section: Discussionmentioning

confidence: 99%

Clinical application of metallic stents in treatment of esophageal carcinoma

Yang¹

2004

WJG

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“…The main advantages include: conscious sedation during the procedure, stent placement in stricture segments without need of excessive dilation, its malleability adapts better to bends or curvatures in some stenosis and it is the treatment of choice in tracheo-esophageal fistulas with a success rate of more than 70% 2,6,7,9,20,29,30,31 .…”

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Assesment of placement of the esophageal self-expandable metallic stent in esophageal cancer in patients with or without citorreduction therapy

Kamiyama

Sakai

Moura

et al. 2007

ABCD, arq. bras. cir. dig.

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BACKGROUND: Placement of self-expanding metallic esophageal stent in patients with advanced esophageal cancer offers excellent palliation of dysphagia and tracheo-esophageal fistulas. However, the safety of stent in patients undergoing radio and/or chemotherapy is controversial, in terms of the greater risk of complications in cases where these two treatments are used in conjunction. AIM: To assess the use of stent in patients with advanced cancer of the mid-thoracic esophagus, by comparing patients undergoing cytoreductive therapy with patients who have not undergone this treatment, in relation to improvement in the dysphagia, rate of complications, period of effectiveness and survival time. METHODS: Fifty seven patients were evaluated retrospectively (16 women and 41 men, with an average age 62 years) with advanced squamous cell carcinoma of the mid-thoracic esophagus who underwent placement of the Ultraflex™ self-expandable metallic coated stent, at the Gastrointestinal Endoscopy Unit of São Paulo University Medical School between October 1988 and October 2004. Out of the 57 patients, 24 patients received adjuvant cytoreductive therapy, and 33 patients were only treated with the stent placement. RESULTS: After stent placement, there was improvement in dysphagia in both groups; there were no differences in the rate of complications, such as migration, pain, fistula, obstruction and compression of the airways; the period of effectiveness was significantly higher in the group submitted to cytoreductive therapy (average 123 days compared to 63 days), as was the survival time (average of 210 days, compared with 120 days). CONCLUSIONS: Improvement in dysphagia was statistically significant in both groups, irrespective of whether the patient had undergone adjuvant cytoreductive therapy; there were no differences in the rate of complications between the two groups and both the period of effectiveness of the stent treatment and the survival time were higher in the group with adjuvant cytoreductive therapy.

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“…In addition, brachytherapy as a sole treatment is frequently used in Western Europe, South Africa, Japan and to a lesser extent in the USA. Both stent placement and brachytherapy have been proven to be effective in relieving dysphagia with a low complication rate, but recurrent dysphagia due to various causes is seen in 30 -40% of patients (Brewster et al, 1995;Kozarek et al, 1996;Bartelsman et al, 2000;Siersema et al, 2001;Sur et al, 2002; Homs et al, 2003a).In order to comprehensively assess the relative merits of the different palliative treatments of malignant dysphagia, health economic aspects should be incorporated. Remarkably, the economic implications of both stent placement and brachytherapy have been evaluated only in a few studies (Adam et al, 1997;Farndon et al, 1998;Nicholson et al, 1999;Dallal et al, 2001;O'Donnell et al, 2002).…”

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confidence: 99%

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confidence: 99%

“…Most of these patients require palliative treatment to relieve progressive dysphagia (Sagar et al, 1994). Treatment options presently available for palliation of dysphagia include selfexpanding metal stent placement (Kozarek et al, 1996;Bartelsman et al, 2000;Siersema et al, 2001), laser therapy (Dallal et al, 2001), photodynamic therapy (PDT) (Luketich et al, 2000;Moghissi et al, 2000), external beam radiation in combination with brachytherapy (Taal et al, 1996;Schraube et al, 1997), brachytherapy as a sole treatment (Jager et al, 1995;Sur et al, 2002;Homs et al, 2003a) and dilatation (Lundell et al, 1989). A disadvantage of laser therapy is that repeated treatment sessions are required to achieve and maintain adequate palliation (Dallal et al, 2001;Spencer et al, 2002).…”

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confidence: 99%

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Cost study of metal stent placement vs single-dose brachytherapy in the palliative treatment of oesophageal cancer

2004

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Self-expanding metal stent placement and single-dose brachytherapy are commonly used for the palliation of oesophageal obstruction due to inoperable oesophagogastric cancer. We randomised 209 patients to the placement of an Ultraflex stent (n ¼ 108) or single-dose brachytherapy (12 Gy, n ¼ 101). Cost comparisons included comprehensive data of hospital costs, diagnostic interventions and extramural care. We acquired detailed information on health care consumption from a case record form and from monthly home visits by a specialised nurse. The initial costs of stent placement were higher than the costs of brachytherapy (h1500 vs h570; Po0.001). Total medical costs were, however, similar (stent h11 195 vs brachytherapy h10 078, P40.20). Total hospital stay during follow-up was 11.5 days after stent placement vs 12.4 days after brachytherapy, which was responsible for the high intramural costs in both treatment groups (stent h6512 vs brachytherapy h7982, P40.20). Costs for medical procedures during follow-up were higher after stent placement (stent h249 vs brachytherapy h168, P ¼ 0.002), while the costs of extramural care were similar (h1278 vs h1046, P40.20). In conclusion, there are only small differences between the total medical costs of both palliative treatment modalities, despite the fact that the initial costs of stent placement are much higher than those of brachytherapy. Therefore, cost considerations should not play an important role in decision making on the appropriate palliative treatment strategy for patients with malignant dysphagia. The incidence of oesophageal cancer has risen rapidly, due to a marked increase in the incidence of adenocarcinoma (Devesa et al, 1998;Botterweck et al, 2000). Oesophageal cancer is a disease with a high mortality, as reflected by a 5-year survival of 10 -15% (Pisani et al, 1999). Moreover, more than 50% of patients with oesophageal cancer have already inoperable disease at presentation. Most of these patients require palliative treatment to relieve progressive dysphagia (Sagar et al, 1994). Treatment options presently available for palliation of dysphagia include selfexpanding metal stent placement (Kozarek et al, 1996;Bartelsman et al, 2000;Siersema et al, 2001), laser therapy (Dallal et al, 2001), photodynamic therapy (PDT) (Luketich et al, 2000;Moghissi et al, 2000), external beam radiation in combination with brachytherapy (Taal et al, 1996;Schraube et al, 1997), brachytherapy as a sole treatment (Jager et al, 1995;Sur et al, 2002; Homs et al, 2003a) and dilatation (Lundell et al, 1989). A disadvantage of laser therapy is that repeated treatment sessions are required to achieve and maintain adequate palliation (Dallal et al, 2001;Spencer et al, 2002). A combined treatment of external beam radiation with brachytherapy is often too intensive for patients with inoperable disease due to metastases or a poor medical condition. Photodynamic therapy involves the local destruction of tumour tissue by light of a specific wavelength activating a previously administered photo...

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Palliation of patients with esophagogastric neoplasms by insertion of a covered expandable modified Gianturco-Z endoprosthesis: experiences in 153 patients

Cited by 120 publications

References 21 publications

Clinical application of metallic stents in treatment of esophageal carcinoma

Clinical application of metallic stents in treatment of esophageal carcinoma

Assesment of placement of the esophageal self-expandable metallic stent in esophageal cancer in patients with or without citorreduction therapy

Cost study of metal stent placement vs single-dose brachytherapy in the palliative treatment of oesophageal cancer

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