Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy.
BACKGROUND
Self-expanding metallic stents (SEMS) are effective in relieving the symptoms of obstructing esophagogastric malignancy. While complications with SEMS have been described, factors influencing such occurrence have not been defined.


METHODS
Self-expanding Gianturco-Rosch Z-stents were placed successfully in 59 patients with obstructing esophagogastric malignancies.


RESULTS
Early procedure-related complications occurred in 6 patients (10%) and were usually minor. Twenty-three late complications occurred in 22 patients (37.5%). Life-threatening complications occurred in 9 patients (15%), including gastrointestinal bleeding (7), perforation (1), and tracheoesophageal fistula (1) and contributed to all five deaths. Eight of 22 patients with prior radiation and/or chemotherapy (36.4%) had life-threatening complications compared to 1 of 37 (2.5%) without prior therapy (p = 0.001). Stent-related mortality occurred in 5 of 22 (23%) patients with prior therapy compared to none of the 37 without prior therapy (p = 0.005). Multivariate analysis confirmed the association between prior radiation and/or chemotherapy and life-threatening complications (p = 0.012; odds ratio, 32.63) and also an association with female gender (p = 0.032; odds ratio, 13.9). There was no association with tumor location or length, histologic type, age, prestent dysphagia grade, or previous surgical resection.


CONCLUSIONS
Patients with prior radiation and/or chemotherapy have an increased risk of severe complications following placement of SEMS.
Kinsman
K J
KJ
Division of Gastroenterology, Oregon Health Sciences University, Portland 97210-3098, USA.
DeGregorio
B T
BT
Katon
R M
RM
Morrison
K
K
Saxon
R R
RR
Keller
F S
FS
Rosch
J
J
D000230:Adenocarcinoma / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods; D011878:Radiotherapy; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013274:Stomach Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy*
D000970:Antineoplastic Agents