Plastic prosthesis versus expandable metal stents for palliation of inoperable esophageal thoracic carcinoma: a controlled prospective study

Palma, Giovanni Domenico De; Matteo, E. Di; Romano, G.; Fimmanò, A; Rondinone, Gennaro; Catanzano, C

doi:10.1016/s0016-5107(96)70290-0

Cited by 201 publications

(17 citation statements)

References 13 publications

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“…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)(6)(7). Uncovered SEMS rapidly replaced rigid stents for management of malignant dysphagia (8).…”

Section: Original Articlesupporting

confidence: 75%

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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: Original Articlesupporting

confidence: 75%

“…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).…”

mentioning

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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“…However, metal stents were associated with fewer complications, shorter hospitalisation after stent placement and superior cost effectiveness (Knyrim et al, 1993). Subsequent randomised studies and a retrospective review produced similar results (De Palma et al, 1996;Roseveare et al, 1998;Eickhoff et al, 2005). Furthermore, the perforation rates and early mortality rates were lower in those patients receiving SEMS.…”

Section: Oesophageal Stents For Malignant Oesophageal Obstructionmentioning

confidence: 88%

Stents in Gastrointestinal Endoscopy

Pavlides¹,

Gorard²

2011

Therapeutic Gastrointestinal Endoscopy

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“…[8][9][10][11] Me an sur vi val ti me fol lo wing stent pla ce ment is re por ted between 2.6 and 5.6 months. 12,13 The re are no ab so lu te con tra in di ca ti ons for esop ha ge al stent pla ce ment. Re la ti ve con tra in di ca tions are ab nor mal co a gu la ti on pro fi le (INR> 1.5 and pla te lets <50.000) and re cent high do se of che mothe raphy/ra di ot he raphy (3-6 we eks) which in cre a se the risk of he morr ha ge and per fo ra ti on, se ve rely ill pa ti ents with li mi ted li fe ex pec tancy, obs truc ti ve lesi on of the sto mach and/or of the small bo wel du e to pe ri to ne al se e ding, se ve re trac he al com pres si on that wo uld be ma de wor se by esop ha ge al in tu ba ti on and ex tre mely high ste no ses clo se to vo cal cords.…”

Section: Discussionmentioning

confidence: 99%

Palliative Treatment of Malignant Inoperable Esophageal Strictures with Self-Expandable Metallic Stents: Single Center Experience with 155 Patients

Hekįmoğlu¹,

Özbal²,

Dönmez³

et al. 2011

Turkiye Klinikleri J Med Sci

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A AB BS S T TR RA AC CT T O Ob b j je ec c t ti i v ve e: : A ret ros pec ti ve study was de sig ned to in ves ti ga te the suc cess and the comp li ca ti on ra tes of dif fe rent types of self-ex pan dab le me tal lic stents in pa ti ents with ino pe rab le ma lig nant esop ha ge al stric tu res. M Ma a t te e r ri i a al l a an nd d M Me et t h ho od ds s: : One hundred fifty five pa ti ents with malig nant esop ha ge al stric tu res re ce i ved self-ex pan dab le me tal lic stents un der flu o ros co pic gu i dance in our cli nic bet we en the ye ars 1994 and 2008. A to tal of 137 men and 18 wo men aged bet we en 26-83 ye ars (me an age, 58.9 ye ars) we re inc lu ded in the study. Stent types used inc lu de Strec ker, Wall stent, co ve red Wall stent, Fla min go Wall stent, Cho o Stent and Song Stent. Comp li ca ti ons of dif fe rent stent types and dyspha gi a sco res of the pa ti ents we re eva lu a ted both pri or to the stent place ment and af ter wards. R Re e s su ul lt ts s: : Stent de li very tec ni qu e was suc cess ful in all pa ti ents. The ave rage dyspha gi a sco re dec re a sed from 3.1 (dyspha gi a to li qu ids) to 1.2 (dyspha gi a to nor mal so lid fo od) pro vi ding a 1.9 im pro ve ment in the dyspha gi a sco re. In eight ca ses (5.2%) early comp li ca ti ons such as mal po si ti on and early mig ra ti on we re de tec ted. In 30 ca ses (19.4%) la te comp li ca ti ons such as in growth, over growth, co e xis ten ce of in growth and over growth, la te mig ra ti on, esop ha gobronc hi al fis tu la and ble e ding we re de tec ted. C Co on nc c l lu u s si i o on n: : Pla ce ment of self-ex pan dab le me tal lic stents in the pal li a ti ve tre at ment of ma lig nant esop ha ge al stric tu res is an ea sily app li ed, well-tole ra ted and ef fec ti ve met hod which im pro ves the dyspha gi a sco re of the pa ti ents with low compli ca ti on ra tes. Our re sults are in ag re e ment with the li te ra tu re. The se lec ti on of the ide al stent for each pa ti ent is of gre at im por tan ce. K Ke ey y W Wo or rd ds s: : Stents; esop ha ge al ste no sis; ra di og raphy, in ter ven ti o nal; flu o ros copy Ö ÖZ ZE ET T A Am ma aç ç: : Ame li yat edi le me yen ma lign özo fa gus dar lı ğı olan has ta la rın pal ya tif te da vi sin de kendi li ğin den ge niş le ye bi len me ta lik stent le rin ba şa rı sı nı ve de ği şik stent tip le ri nin komp li kas yon oranla rı nı or ta ya koy mak için ret ros pek tif bir ça lış ma ya pıl dı. G Ge e r re eç ç v ve e Y Yö ön n t te em m l le er r: : Ma lign özo fa gus dar lı ğı olan 155 has ta ya kli ni ği miz de 1994 ve 2008 yıl la rı ara sın da flo ros ko pik kı la vuz ile ken di ken di ne ge niş le ye bi len me ta lik stent ler ta kıl dı. Yaş la rı 26-83 yıl ara sın da de ği şen (or ta la ma yaş 58.9 yıl) top lam 137 er kek ve 18 ka dın ça lış ma ya alın dı. Kul la nı lan stent tip le ri Strec ker, Wall stent, kaplan mış Wall stent, Fla min go Wall stent, Cho o Stent ve Song Stent 'dir. De ği şik stent tip le riy le ge lişen komp li kas yon lar ve has ta la rın ste...

show abstract

Plastic prosthesis versus expandable metal stents for palliation of inoperable esophageal thoracic carcinoma: a controlled prospective study

Cited by 201 publications

References 13 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.

Stents in Gastrointestinal Endoscopy

Palliative Treatment of Malignant Inoperable Esophageal Strictures with Self-Expandable Metallic Stents: Single Center Experience with 155 Patients

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