title: Use of the 25 mm flanged esophageal Z stent for malignant dysphagia: a prospective multicenter trial.
abstract: BACKGROUND
  An initial multicenter study using a 21 mm flanged esophageal Z stent demonstrated excellent palliation but an 11% immediate complication rate at placement and a 27% migration rate at 1 month. This North American multicenter trial prospectively studied a 25 mm flanged Z stent to define its palliative ability and whether the increased diameter affected placement or migration problems.
  
  
  METHODS
  Fifty patients who had esophageal Z stents at seven university or regional referral hospitals were prospectively studied. Indications for prosthesis placement, previous therapy, patient demographics, incidence of concomitant tracheoesophageal fistula, and degree of dysphagia were defined, as were procedural and subsequent stent-related problems, survival times, the ability to occlude a tracheoesophageal fistula, and subsequent degree of dysphagia.
  
  
  RESULTS
  Twenty-four patients had infiltrating malignancy (16 exophytic and 10 extrinsic), 9 of whom had concomitant tracheoesophageal fistulas. Ten patients (20%) had misplaced stents requiring retrieval and replacement, 12 patients (24%) had subsequent stent-related problems including exsanguination (2), aspiration (3), tumor overgrowth (3), and postplacement migration (4) (8%). There was statistically significant improvement in prestent versus poststent dysphagia and two thirds of patients had complete occlusion of their tracheoesophageal fistula.
  
  
  CONCLUSIONS
  Redesign of the esophageal Z stent has decreased the migration rate without increasing placement or subsequent erosion problems. Its efficacy appears comparable to the currently marketed Z stent for the palliation of malignant dysphagia and occlusion of tracheoesophageal fistula.
authors.affiliation: Virginia Mason Medical Center, Seattle, Washington 98101, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Kozarek
authors.forename: S
authors.initials: S
authors.lastname: Raltz
authors.forename: N
authors.initials: N
authors.lastname: Marcon
authors.forename: P
authors.initials: P
authors.lastname: Kortan
authors.forename: G
authors.initials: G
authors.lastname: Haber
authors.forename: C
authors.initials: C
authors.lastname: Lightdale
authors.forename: P
authors.initials: P
authors.lastname: Stevens
authors.forename: G
authors.initials: G
authors.lastname: Lehman
authors.forename: D
authors.initials: D
authors.lastname: Rex
authors.forename: S
authors.initials: S
authors.lastname: Benjamin
authors.forename: D
authors.initials: D
authors.lastname: Fleischer
authors.forename: R
authors.initials: R
authors.lastname: Bashir
authors.forename: S
authors.initials: S
authors.lastname: Fry
authors.forename: I
authors.initials: I
authors.lastname: Waxman
authors.forename: J
authors.initials: J
authors.lastname: Benson
authors.forename: J
authors.initials: J
authors.lastname: Polio
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000150:complications*; D004940:Esophageal Stenosis / Q000150:complications / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D015607:Stents; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000628:therapy