title: Clinical outcomes of esophageal stents in patients with malignant esophageal obstruction according to palliative additional treatment.
abstract: OBJECTIVE
  To evaluate the efficacy and feasibility of esophageal self-expanding metal stents (SEMS) insertion for malignant esophageal obstruction (MEO) in patients with or without additional palliative treatment.
  
  
  METHODS
  We retrospectively reviewed the medical records of the patients with SEMS for MEO. Baseline characteristics, changes in Mellow-Pinkas dysphagia score, and adverse events were collected and compared according to the presence and absence of additional palliative treatment.
  
  
  RESULTS
  Altogether 192 patients underwent 236 SEMS insertion procedures. Esophageal, gastric cardiac and lung cancers were seen in 46.4%, 33.3% and 15.1% of the patients, respectively. Their Mellow-Pinkas score significantly decreased within one week and one month after the SEMS insertion (1.66 ± 0.79 and 1.71  ±  0.87 vs 3.09  ±  0.79, respectively, P =  0.000). Complications occurred in 54 (22.9%) of 236 SEMS insertion; there were 28 (11.9%) stent obstruction, 5 (2.1%) perforation (2.1%), 10 (4.2%) stent migration, 5 (2.1%) tracheoesophageal fistula, but no procedure-related death. Most complications were managed by inserting additional SEMS. The risk of stent obstruction was significantly higher in uncovered stents than in covered SEMS (OR 3.56, 95% CI 1.39-9.12, P = 0.006). Mean duration to the development of complications was 74.8 ± 111.1 days. Overall survival (169.0 ± 127.8 days vs 96.4 ± 90.6 days, P = 0.000) and stent patency (143.3 ± 123.9 days vs 67.6 ± 71.3 days, P = 0.000) were significantly favorable in patients with SEMS and additional palliative treatments compared with those with SEMS alone.
  
  
  CONCLUSIONS
  SEMS insertion is effective and safe for treating MEO, and additional palliative treatment might lengthen stent patency by prolonging the patient's survival.
authors: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine.
authors: Ji Yeon
authors: JY
authors: Kim
authors: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine.
authors: Sang Gyun
authors: SG
authors: Kim
authors: Department of Intestinal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
authors: Joo Hyun
authors: JH
authors: Lim
authors: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine.
authors: Jong Pil
authors: JP
authors: Im
authors: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine.
authors: Joo Sung
authors: JS
authors: Kim
authors: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine.
authors: Hyun Chae
authors: HC
authors: Jung
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000150:complications; D004939:Esophageal Perforation / Q000209:etiology; D004940:Esophageal Stenosis / Q000209:etiology / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D011475:Prosthesis Failure / Q000209:etiology; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects*; D012720:Severity of Illness Index; D013997:Time Factors; D014138:Tracheoesophageal Fistula / Q000209:etiology; D016896:Treatment Outcome
keywords: efficacy; esophageal neoplasms; malignant obstruction; palliation; self-expanding metal stent