Palliation of malignant esophageal obstruction due to intrinsic and extrinsic lesions with expandable metal stents.
OBJECTIVE
Metal stents have become the standard of care for esophageal stenting. The aim of this study was to determine the safety and efficacy of metal stents for the palliation of dysphagia caused by extraesophageal malignancies compressing the esophagus, compared with that caused by intrinsic lesions involving the esophagus.


METHODS
Expandable metal stents were placed in 46 consecutive patients with dysphagia caused by malignant extrinsic compression of the esophagus (n=24) and intrinsic esophageal strictures (n=22). Quality of life was determined by a dysphagia score and the Karnofsky performance scale. Patients were followed until death.


RESULTS
Stents were successfully deployed in all 24 patients. Dysphagia scores improved from a median of 3 (range, 3-4; mean, 3.5+/-0.2) to a median of 2 (range, 1-4; mean, 1.6+/-0.4; p < 0.0001) in the extrinsic group, and from a median of 3 (range, 2-4) to a median of 1 (range, 1-3) in the intrinsic group (p < 0.0001). The improvement was significantly greater (p=0.01) in the intrinsic group. There was no significant difference in the Karnofsky score between the two groups.


CONCLUSIONS
Patients with intrinsic lesions have better palliation of dysphagia than those with extrinsic lesions. Future studies with other study designs will need to consider this.
Krankenhaus Neukölln, Berlin, Germany.
N
N
Bethge
A
A
Sommer
N
N
Vakil
D000368:Aged; D016022:Case-Control Studies; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004938:Esophageal Neoplasms / Q000150:complications; D004940:Esophageal Stenosis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D017567:Karnofsky Performance Status; D009369:Neoplasms / Q000150:complications; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D015607:Stents; D016896:Treatment Outcome