Delayed complications after esophageal stent placement for treatment of malignant esophageal obstructions and esophagorespiratory fistulas.
OBJECTIVE
To evaluate delayed complications after esophageal expandable metallic stent placement.


METHODS
From April 1993 to December 1997, 90 expandable metallic stents were placed in 82 consecutive patients with inoperable malignant esophageal obstruction (n = 49) or malignant esophagorespiratory fistula (n = 33). Stents used included covered Gianturco-Rosch Z stents (n = 20), Wallstents (covered, n = 31; uncovered, n = 13), and Ultraflex stents (covered, n = 8; uncovered, n = 10). Patients were followed prospectively and monitored for delayed complications, defined as major (hemorrhage, tracheal compression, stent migration, perforation or fistula formation, granulomatous obstruction, tumor ingrowth and overgrowth, funnel phenomenon, and stent covering disruption) or minor (reflux, chest pain, and food impaction).


RESULTS
Mean survival was 4.5 months after stent placement (range, 3 weeks to 26 months). The overall incidence of delayed complications was 64.6%, with 17 patients (20.7%) experiencing more than one complication. The rates of delayed complications in patients with Z stents, Wallstents, and Ultraflex stents were 75.0%, 68.1%, and 44.4%, respectively (P <.05). Most complications were life-threatening and occurred more frequently when stents were placed in the proximal third of the esophagus, compared with more distally (P <.05). Thirteen patients (15.9%) died from complications directly related to stent placement.


CONCLUSIONS
Esophageal stent placement for malignant obstruction or fistula is associated with a substantial incidence of delayed complications.
Wang
M Q
MQ
Division of Cardiovascular and Interventional Radiology, Stanford University Medical Center, Stanford, CA 94305, USA.
Sze
D Y
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Wang
Z P
ZP
Wang
Z Q
ZQ
Gao
Y A
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Dake
M D
MD
D000368:Aged; D016009:Chi-Square Distribution; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012142:Respiratory Tract Neoplasms / Q000150:complications / Q000628:therapy*; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate