Are metal stents effective for palliation of malignant dysphagia and fistulas?
BACKGROUND
One of the available treatments for unresectable oesophagogastric malignancies is the insertion of metal stents.


OBJECTIVE
We evaluated prospectively 147 patients suffering from malignant dysphagia and/or fistula, after inserting a self-expandable metal stent.


METHODS
The study included 147 patients (87 males, mean age 73 years). Dysphagia before and after stent placement was scored. Patients were divided in two groups according to dysphagia grade: group A (grade 0, 1) and group B (grades 2, 3, 4). Three types of stents were used: the Ultraflex stent (covered and uncovered) and the Flamingo one (covered). The total number of self-expandable metal stents placed was 183. A total of 92 of them were inserted following the combined endoscopic and fluoroscopic approach (42 by injecting lipiodol), while 91 were placed under endoscopic control only. Early and late complications were evaluated.


RESULTS
Mean dysphagia score in group A, 1 day and 1 month after the procedure, was slightly reduced from 0.8 to 0.5/0.6 (p=NS), respectively. However, there was a statistically significant improvement (p<0.001) of mean dysphagia score in group B, from 2.4 initially to 1.1/1.4. Early complications occurred in 37 cases, late ones in 51. According to severity, minor complications occurred in 24 patients, major in 42, while life-threatening ones in 22. Survival ranged from 1 to 611 days and 1-week mortality was 9%. Stent-related death occurred in six patients.


CONCLUSIONS
All kinds of endoscopic methods used for stenting in the present study were easy to perform even on an out-patient basis. Insertion of self-expandable metal stents is effective in patients with dysphagia scores > or = 2. It might not clinically improve patients with dysphagia score <2, so selection of patients for stenting is essential to avoid unnecessary procedures. Moreover, their high cost, high complication rates and low overall survival may improve following better selection criteria.
Kostopoulos
P P
PP
Gastroenterology Unit, Blackpool Victoria Hospital, Blackpool FY3 8NR, UK.
Zissis
M I
MI
Polydorou
A A
AA
Premchand
P P
PP
Hendrickse
M T
MT
Shorrock
C J
CJ
Isaacs
P E T
PE
D000230:Adenocarcinoma / Q000150:complications; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications; D003680:Deglutition Disorders / Q000145:classification / Q000209:etiology / Q000628:therapy*; D004937:Esophageal Fistula / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis