title: Antireflux stent versus conventional stent in the palliation of distal esophageal cancer. A randomized, multicenter clinical trial.
abstract: 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.
authors.affiliation: Upper GastroIntestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. john.blomberg@karolinska.se
authors.forename: John
authors.initials: J
authors.lastname: Blomberg
authors.forename: Urs
authors.initials: U
authors.lastname: Wenger
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
authors.forename: Urban
authors.initials: U
authors.lastname: Arnelo
authors.forename: Torhallur
authors.initials: T
authors.lastname: Agustsson
authors.forename: Erik
authors.initials: E
authors.lastname: Johnsson
authors.forename: Ervin
authors.initials: E
authors.lastname: Toth
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lagergren
mesh_terms: 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