Coated self-expanding metal stents versus latex prostheses for esophagogastric cancer with special reference to prior radiation and chemotherapy: a controlled, prospective study.
BACKGROUND
Self-expanding metal stents seem to be safer than conventional prostheses for palliation of malignant esophagogastric obstruction. However, recurrent dysphagia caused by tumor ingrowth in uncoated types remains a problem. In addition, prior radiation and/or chemotherapy may entail an increased risk of complications.


METHODS
Seventy-five patients with an esophagogastric carcinoma were randomly assigned to placement of a latex prosthesis under general anesthesia or a coated, self-expanding metal stent under sedation. At entry, patients were stratified for location of the tumor in the esophagus or cardia and for prior radiation and/or chemotherapy.


RESULTS
Technical success and improvement in dysphagia score were similar in both groups. Major complications were more frequent with latex prostheses (47%) than with metal stents (16%) (odds ratio 4.07: 95% CI [1.35, 12.50], p = 0.014). Recurrent dysphagia was not different between latex prostheses (26%) and metal stents (24%). Hospital stay was longer, on average, after placement of latex prostheses than metal stents (6.3 +/- 5.2 versus 4.3 +/- 2.3 days; p = 0.043). Only prior radiation and/or chemotherapy increased the risk of specific device-related complications with respect to the esophagus (12 of 28 [43%] versus 8 of 47 [17%]; odds ratio 3.66: 95% CI [1.24, 10.82], p = 0.029).


CONCLUSIONS
Coated, self-expanding metal stents are associated with fewer complications and shorter hospital stay as compared with latex prostheses, and prior radiation and/or chemotherapy increases the risk of device-related complications with respect to the esophagus.
Siersema
P D
PD
Department of Gastroenterology, University Hospital Rotterdam-Dijkzigt, The Netherlands.
Hop
W C
WC
Dees
J
J
Tilanus
H W
HW
van Blankenstein
M
M
D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000150:complications; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D007840:Latex; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012008:Recurrence; D015607:Stents; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
D007840:Latex; D008670:Metals