Self-expanding metal stents versus plastic prostheses in the palliation of malignant dysphagia: long-term outcome of 153 consecutive patients.
BACKGROUND
Malignant dysphagia due to esophagogastric cancer is associated with poor overall prognosis. Placements of self-expandable metal stents or plastic tubes are established methods as palliative treatment options. As an alternative and/or complementary therapy, radiologic techniques (external beam radiation/brachytherapy) and locally endoscopic techniques (laser, APC-beamer, PDT) are often used. STUDY AND GOALS: Retrospective trial of 153 patients treated in our department between 1993 and 2001. Forty-five patients received a plastic tube (Group A) and 108 patients were treated with metal stents (Group B). Both groups were compared for improvement of dysphagia score, survival, recurrent dysphagia and complications.


RESULTS
Stent placement was successful in 41 of 45 (93%) patients of Group A and 107 of 108 (99%) of Group B. The median dysphagia score improved significantly in Group A (from 3.03 to 1.55, P = 0.010) and Group B (from 2.77 to 1.44, P = 0.009). Recurrent dysphagia was noted in 12 of 45 (27%) patients of Group A and 27 of 108 (25%) patients of Group B. Median survival time after stent insertion was 78 days (Group A) and 113 days (Group B). Overall complications occurred in 15 of 45 (33%) patients of Group A and 28 of 108 (26%) patients of Group B. However, significantly (P = 0.05) more major complications were seen in Group A than in Group B (22% vs. 9%).


CONCLUSIONS
Our results indicate a marginal clinical benefit for metal stents versus plastic tubes in malignant dysphagia in the long run. However, metal stents seem to be safer and associated with a prolonged improvement of dysphagia score.
Eickhoff
Axel
A
Medical Department C, Klinikum Ludwigshafen, Bremserstrasse 79, D-67063 Ludwigshafen, Germany. eickhofa@klilu.de
Knoll
Matthias
M
Jakobs
Ralf
R
Weickert
Uwe
U
Hartmann
Dirk
D
Schilling
Dieter
D
Eickhoff
Jens C
JC
Riemann
Jürgen F
JF
D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018196:Carcinoma, Adenosquamous / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D020099:Coated Materials, Biocompatible / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003680:Deglutition Disorders / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008670:Metals / Q000191:economics; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics / Q000379:methods; D010969:Plastics / Q000191:economics; D011474:Prosthesis Design / Q000295:instrumentation; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents / Q000191:economics; D013274:Stomach Neoplasms / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible; D008670:Metals; D010969:Plastics