[Comparison of 3 types of covered self-expanding metal stents for the palliation of malignant dysphagia: results from the prospective Ludwigshafen Esophageal Cancer Register].
BACKGROUND
Endoscopic stenting with self-expanding metal stents (SEMS) has proved to be an efficient palliative endoscopic therapy option in treating malignant dysphagia. Different types of SEMS have been examined previously in small randomized clinical trials.


METHODS
A total of 150 consecutive patients (from 1/1995-1/2004; 35 females, 115 males) with a median age of 66 years (range 43-94 years) were evaluated. Three different types of SEMS were examined: Group A: Gianturco Z Stent n = 59 pts.; Gruppe B: Ultraflex Stent n = 49 pts.; Gruppe C: Flamingo Wallstent n = 42 pts.). Dysphagia was categorized into grade 0 (no dysphagia) to grade 4 (total obstruction).


RESULTS
Stent insertion was successfully evaluated in 55/59 (93 %) of the patients in group A, in 47/49 (96 %) of the patients in group B and in 40/42 (95 %) of the patients in group C (p = 0.78). After stent insertion, a reduction in the dysphagia score from 2.77 to 0.99 was observed in group A, from 2.58 to 0.72 in group B and from 2.62 to 0.81 in group C (p = 0.37). The median time to dysphagia recurrence was 78 days in group A, 90 days in group B and 70 days in group C (p = 0.45). The median overall survival time was 96 days in group A, 118 days in group B and 108 days in group C (p = 0.18). The incidence of high grade complications was 34 % in group A, 16 % in group B and 17 % in group C (p = 0.04).


CONCLUSIONS
The 3 types of SEMS examined in this study showed similar efficacies in treating malignant dysphagia. However, the major complication rate of the Gianturco Z stent was significantly higher when compared to the complication rate of the Ultraflex stent and the Flamingo Wallstent.
Eickhoff
A
A
Medizinische Klinik C, Klinikum Ludwigshafen gGmbH. eickhofa@klilu.de
Hartmann
D
D
Jakobs
R
R
Weickert
U
U
Schilling
D
D
Eickhoff
J C
JC
Riemann
J F
JF
D000230:Adenocarcinoma / Q000150:complications*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications*; D002299:Cardia; D016009:Chi-Square Distribution; D003627:Data Interpretation, Statistical; D003680:Deglutition Disorders / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004724:Endoscopy; D004938:Esophageal Neoplasms / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D019919:Prosthesis Implantation; D012008:Recurrence; D012042:Registries; D015607:Stents / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome