Long-term safety and outcome of a temporary self-expanding metallic stent for achalasia: a prospective study with a 13-year single-center experience.
To prospectively evaluate the long-term clinical safety and efficacy of a newly designed self-expanding metallic stent (SEMS) in the treatment of patients with achalasia. Seventy-five patients with achalasia were treated with a temporary SEMS with a 30-mm diameter. The SEMSs were placed under fluoroscopic guidance and removed by gastroscopy 4-5 days after stent placement. Follow-up data focused on dysphagia score, technique and clinical success, clinical remissions and failures, and complications and was performed at 6 months, 1 year, and within 3 to 5 years, 5 to 8 years, 8 to 10 years, and >10 years postoperatively. Stent placement was technically successful in all patients. Complications included stent migration (n = 4, 5.33%), chest pain (n = 28, 38.7%), reflux (n = 15, 20%), and bleeding (n = 9, 12%). No perforation or 30-day mortality occurred. Clinical success was achieved in all patients 1 month after stent removal. The overall remission rates at 6 months, 1, 1-3, 3-5, 5-8, 8-10, and >10 year follow-up periods were 100%, 96%, 93.9%, 90.9%, 100%, 100%, and 83.3%, respectively. Stent treatment failed in six patients, and the overall remission rate in our series was 92%. The median and mean primary patencies were 2.8 +/- 0.28 years (95% CI: 2.25-3.35) and 4.28 +/- 0.40 years (95% CI: 3.51-5.05), respectively. The use of temporary SEMSs with 30-mm diameter proved to be a safe and effective approach for managing achalasia with a long-term satisfactory clinical remission rate.
Zhao
Jun-Gong
JG
Department of Radiology, The Tenth Affiliated People's Hospital, Shanghai Tong Ji University, No. 301, Middle Yan Chang Road, Shanghai, China.
Li
Yong-Dong
YD
Cheng
Ying-Sheng
YS
Li
Ming-Hua
MH
Chen
Ni-Wei
NW
Chen
Wei-Xiong
WX
Shang
Ke-Zhong
KZ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003680:Deglutition Disorders / Q000209:etiology* / Q000517:prevention & control*; D004931:Esophageal Achalasia / Q000150:complications* / Q000628:therapy*; D005260:Female; D006801:Humans; D007440:Intubation / Q000295:instrumentation* / Q000379:methods*; D008137:Longitudinal Studies; D008297:Male; D008670:Metals; D008875:Middle Aged; D010865:Pilot Projects; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult
D008670:Metals