Antireflux stent versus conventional stent in the palliation of distal esophageal cancer. A randomized, multicenter clinical trial.
OBJECTIVE
Patients with incurable distal esophageal or cardia cancer often need palliative stenting to relieve their dysphagia but stents passing through the cardia can cause reflux and aspiration, leading to a reduced health-related quality of life (HRQL). This study addressed the hypothesis that antireflux stenting improves HRQL compared to conventional stenting.


METHODS
In a single-blind, multicenter, randomized trial in patients with inoperable esophageal or cardia cancer requiring palliative stenting passing through the cardia, 65 patients were stented. Patients received either an antireflux stent (Esophageal Z-Stent with Dua antireflux valve; n = 28) or a conventional stent (Esophageal Z-stent, Ultraflex or Wallstent; n = 37). Validated questionnaires (European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-OES18) were used to collect information on HRQL at baseline and 1 and 3 months after stenting. Main outcome measurements were differences in HRQL scores between baseline and 1 and 3 months after stenting.


RESULTS
Scores for most aspects of HRQL were similar in the two groups, and no statistically significant differences were found. Some general symptoms however showed clinically relevant improvement in the antireflux stent group, while esophageal-specific symptoms such as dysphagia seemed clinically better, and symptoms of reflux were clinically reduced in the conventional stent group but not in the antireflux stent group.


CONCLUSIONS
This study, although limited in size, provided no obvious support for using the antireflux stent in preference to the conventional stent in the palliation of distal esophageal or cardia cancer from an HRQL perspective.
Blomberg
John
J
Upper GastroIntestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. john.blomberg@karolinska.se
Wenger
Urs
U
Lagergren
Jesper
J
Arnelo
Urban
U
Agustsson
Torhallur
T
Johnsson
Erik
E
Toth
Ervin
E
Lagergren
Pernilla
P
D000368:Aged; D003680:Deglutition Disorders / Q000150:complications / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D004942:Esophagitis, Peptic / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D010166:Palliative Care; D011788:Quality of Life; D015607:Stents; D015996:Survival Rate