title: Management of inoperable malignant oesophageal strictures with fully covered WallFlex(®) stent: a multicentre prospective study.
abstract: BACKGROUND
  The majority of currently available oesophageal metal stents are partially covered to reduce migration risk. Preliminary experiences with fully covered stents seem to indicate an increased risk of migration in patients treated for malignant dysphagia. The aim of our study was to determine, in this setting, the safety and efficacy of a new, recently introduced stent with anti-migration proprieties.
  
  
  METHODS
  We designed a prospective, multicentre, non-randomized, follow-up study in nine tertiary referral centres. Eighty-two patients with dysphagia due to inoperable or metastatic oesophageal cancer were included. In all of them the fully covered WallFlex(®) stent was placed. Main outcome measurements included functional outcome, recurrent dysphagia, complications, and mortality.
  
  
  RESULTS
  Dysphagia score improved from a median of 3, before stenting, to 1 at 4 weeks after stent placement (P<0.001). Perforation occurred in 1 patient after 39 days, while bleeding was reported in 3. In total, 19 patients (23.1%) developed recurrent dysphagia because of stent migration (N=10, 12.2%), tissue overgrowth (N=7; 8.5%), and food impaction (N=2; 2.4%).
  
  
  CONCLUSIONS
  Placement of the fully covered WallFlex(®) stent resulted in safe and effective palliation of malignant dysphagia, with migration and tissue overgrowth rates comparable to previously reported data on partially covered stents.
authors.affiliation: Humanitas Research Hospital, Rozzano, Milan, Italy. Electronic address: alessandro.repici@humanitas.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.affiliation: Humanitas Research Hospital, Rozzano, Milan, Italy.
authors.forename: Manol
authors.initials: M
authors.lastname: Jovani
authors.affiliation: Humanitas Research Hospital, Rozzano, Milan, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Santa Chiara Hospital, Pisa, Italy.
authors.forename: Biagio
authors.initials: B
authors.lastname: Solito
authors.affiliation: Civic Hospital, Palermo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Mitri
authors.affiliation: Cremona Hospital, Cremona, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Buffoli
authors.affiliation: Acireale Hospital, Acireale, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Macrì
authors.affiliation: Camposampiero Hospital, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Fregonese
authors.affiliation: S. Orsola-Malphigi Hospital University of Bologna, Bologna, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cennamo
authors.affiliation: National Cancer Institute, G. Pascale Foundation - IRCCS, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: De Bellis
authors.affiliation: Humanitas Research Hospital, Rozzano, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Anderloni
authors.affiliation: University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
mesh_terms: D000230:Adenocarcinoma / Q000150:complications*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications*; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Advanced oesophageal cancer; Nutrition; Palliation; SEMS; Self-expanding metal stent