title: A new fully covered metal stent for the treatment of benign and malignant dysphagia: a prospective follow-up study.
abstract: BACKGROUND
  Fully covered self-expandable metal stents (FCSEMSs) are increasingly being used for malignant and benign strictures. Particularly in the latter, FCSEMSs are known for their high migration rates. A new FCSEMS with a dog-bone shape and internal covering was developed to reduce migration risk.
  
  
  OBJECTIVE
  To evaluate recurrent dysphagia and safety of the new FC stent in benign and malignant esophageal disorders.
  
  
  METHODS
  Prospective follow-up study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Between November 2009 and February 2011, 48 consecutive patients (mean age 61 years, range 28-81 years) underwent FC stent placement for malignant (n = 33) or benign (n = 15) dysphagia.
  
  
  METHODS
  FC stent placement.
  
  
  METHODS
  Recurrent dysphagia and complications.
  
  
  RESULTS
  Indications for FC stent placement included esophageal cancer (n = 28), extrinsic malignant compression (n = 4), recurrent malignancy after esophagectomy (n = 1), and refractory benign esophageal stricture (n = 15). In malignant strictures, recurrent dysphagia occurred in 5 patients (15%) because of stent migration (n = 3), tissue overgrowth (n = 1), and acute edema (n = 1). In benign strictures, stents were prematurely removed in 9 (60%) patients because of stent migration (n = 5), tissue overgrowth (n = 3), and pain (n = 1). Recurrent dysphagia occurred in all patients after stent removal. Major complications occurred in 10 patients (30%) with malignant strictures and in 3 patients (20%) with benign strictures and included severe pain and/or vomiting (n = 8), fistula formation (n = 2), bleeding (n = 2), and aspiration pneumonia (n = 1).
  
  
  CONCLUSIONS
  Nonrandomized study design.
  
  
  CONCLUSIONS
  Although the new FC stent effectively treats malignant dysphagia, it is associated with substantial major complications. In patients with refractory benign esophageal strictures, recurrent dysphagia occurs rapidly after removal of the new FC stent.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands. M.M.C.Hirdes@umcutrecht.nl
authors.forename: Meike M C
authors.initials: MM
authors.lastname: Hirdes
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.forename: Frank P
authors.initials: FP
authors.lastname: Vleggaar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003680:Deglutition Disorders / Q000209:etiology* / Q000628:therapy*; D004937:Esophageal Fistula / Q000209:etiology; D004938:Esophageal Neoplasms / Q000150:complications*; D004940:Esophageal Stenosis / Q000150:complications / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011015:Pneumonia, Aspiration / Q000209:etiology; D011446:Prospective Studies; D011475:Prosthesis Failure / Q000009:adverse effects; D012008:Recurrence; D018709:Statistics, Nonparametric; D015607:Stents / Q000009:adverse effects; D014839:Vomiting / Q000209:etiology