title: Outcomes following oesophageal stent insertion for palliation of malignant strictures: A large single centre series.
abstract: BACKGROUND
  Self-expanding metal stents (SEMS) are an accepted intervention for malignant dysphagia. Stents vary in ease of insertion, removability, migration and occlusion rates. This series reports the complications, morbidity and mortality associated with several SEMS.
  
  
  METHODS
  A prospective database of patients undergoing fluoroscopic guided oesophageal stent insertion for malignancy between June 2001 and June 2009 was analysed. Patient demographics, intervention outcomes and tumour variables were correlated with stent failure and patient survival. Multivariate analysis was performed to evaluate predictors for stent failure.
  
  
  RESULTS
  Two hundred and seventy-three stents were deployed using nine different types of SEMS. The median Mellow-Pinkas dysphagia score significantly improved from 3 to 1 post-stent insertion (P < 0.001), with a technical success rate of 98%. Stent complications occurred in 95 (36%) patients [recurrent dysphagia n = 49 (19%), migration n = 24 and occlusion n = 25]. Multivariate analysis demonstrates that the covered Niti S stent fails significantly more than the double-layered Niti S stent (OR = 4, P < 0.005).
  
  
  CONCLUSIONS
  Oesophageal stent insertion provides good palliation for malignant dysphagia, however recurrent dysphagia remains a problem. This major complication occurs more frequently with covered Niti S stents than double-layered Niti S stents. This finding may aid the stent choice used in advanced oesophageal malignancy.
authors.affiliation: Department of Upper GI Surgery, Stockport NHS Foundation Trust, Stepping Hill Hospital, Stockport, Cheshire, UK. nicholasjohnbattersby@gmail.com
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Battersby
authors.forename: Glenn K
authors.initials: GK
authors.lastname: Bonney
authors.forename: Daren
authors.initials: D
authors.lastname: Subar
authors.forename: Laura
authors.initials: L
authors.lastname: Talbot
authors.forename: Bart
authors.initials: B
authors.lastname: Decadt
authors.forename: Niall
authors.initials: N
authors.lastname: Lynch
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000401:mortality / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000401:mortality / Q000628:therapy; D003680:Deglutition Disorders / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D004940:Esophageal Stenosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate; D016896:Treatment Outcome