Metal stents improve dysphagia, nutrition and survival in malignant oesophageal stenosis: a randomized controlled trial comparing modified Gianturco Z-stents with plastic Atkinson tubes.
OBJECTIVE
To compare modified Gianturco metal stents with plastic Atkinson tubes in the palliation of malignant dysphagia.


METHODS
Patient single-blind, multi-centre prospective, randomized trial.


METHODS
Three district general hospitals in the Wessex region.


METHODS
Thirty one consecutive patients with inoperable malignant oesophageal stenosis causing dysphagia and suitable for treatment with an endoprosthesis.


METHODS
Patients were randomized to receive either a modified Gianturco metal stent or a plastic Atkinson tube. Sedation was similar and patients were given identical dietary advice. Data were collected after insertion until the patients' death.


METHODS
Procedural mortality/morbidity; hospital stay; weight loss; quality of life (Nottingham Health Profile, Spitzer QL index and specific questions about dysphagia and enjoyment of food); duration of survival after insertion; cost effectiveness of each intervention.


RESULTS
Overall complication rates were similar in the two groups. Compared with Atkinson tubes, patients with Gianturco stents had better palliation of dysphagia (median dysphagia score 1 vs 2, P = 0.04), maintained their weight longer (median percent weight loss 0.66 vs 6.51, P = 0.007), enjoyed food more (enjoyment score 2 vs 1, P = 0.03) and survived longer (log rank P < 0.025). Patients with metal stents were discharged from hospital earlier (Gianturco 4 days, Atkinson 10 days, P = 0.001), and initial treatment cost was lower if the cost of hospital stay exceeded pound sterling 120 per day.


CONCLUSIONS
Gianturco stents are superior to Atkinson tubes in the palliation of malignant oesophageal stenosis.
Roseveare
C D
CD
Dept of Gastroenterology, Royal Hampshire County Hospital, Winchester, UK. CRoseveare@compuserve.com
Patel
P
P
Simmonds
N
N
Goggin
P M
PM
Kimble
J
J
Shepherd
H A
HA
D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000150:complications; D004940:Esophageal Stenosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D009747:Nutritional Physiological Phenomena; D011446:Prospective Studies; D016037:Single-Blind Method; D015607:Stents; D016019:Survival Analysis