title: Adverse events of self-expandable esophageal metallic stents in patients with long-term survival from advanced malignant disease.
abstract: OBJECTIVE
  Self-expandable metallic stents are considered the best palliative treatment of dysphagia for patients with advanced esophageal cancer. Adverse events (AEs) are a major concern, especially in patients with better prognosis and longer survival. The present study aimed to evaluate the AEs of patients who survived longer than 6 months with esophageal stents in place.
  
  
  METHODS
  This is a retrospective analysis of a prospectively collected database including all patients submitted to esophageal stent placement for the palliation of malignant diseases during the period from February 2009 to February 2014 at a tertiary care academic center who had stents longer than 6 months.
  
  
  RESULTS
  Sixty-three patients were included. Mean follow-up was 10.7 months. Clinical success was achieved in all patients, and the median stent patency was 7.1 months. AEs occurred in 40 patients (63.5%), totaling 62 AEs (mean, 1.5 AEs per patient). Endoscopic management of AEs was successful in 84.5% of cases, with a mean of 1.6 reinterventions per patient. The univariate analysis revealed that performance status, age, and post-stent radiotherapy presented a trend to higher risk of AEs. The multivariate analysis revealed that only performance status was associated with AEs (P = .025; hazard ratio, 4.1).
  
  
  CONCLUSIONS
  AEs are common in patients with long-term esophageal stenting for malignancy. However, AEs were not related to higher mortality rate, and most AEs could be successfully managed by endoscopy. Only performance status was a risk factor for AEs. Our data suggest that metallic stenting is a valid option for the treatment of malignant esophageal conditions, even when survival longer than 6 months is expected.
authors.affiliation: Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Vitor Sousa
authors.initials: VS
authors.lastname: Medeiros
authors.affiliation: Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Bruno Costa
authors.initials: BC
authors.lastname: Martins
authors.affiliation: Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Luciano
authors.initials: L
authors.lastname: Lenz
authors.affiliation: Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Maria Sylvia Ierardi
authors.initials: MSI
authors.lastname: Ribeiro
authors.affiliation: Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Gustavo Andrade
authors.initials: GA
authors.lastname: de Paulo
authors.affiliation: Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Marcelo Simas
authors.initials: MS
authors.lastname: Lima
authors.affiliation: Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Adriana Vaz
authors.initials: AV
authors.lastname: Safatle-Ribeiro
authors.affiliation: Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Fabio Shighuehissa
authors.initials: FS
authors.lastname: Kawaguti
authors.affiliation: Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Caterina
authors.initials: C
authors.lastname: Pennacchi
authors.affiliation: Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Sebastian N
authors.initials: SN
authors.lastname: Geiger
authors.affiliation: Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Victor R
authors.initials: VR
authors.lastname: Bastos
authors.affiliation: Department of Gastroenterology, Surgery Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Ulysses
authors.initials: U
authors.lastname: Ribeiro-Junior
authors.affiliation: Department of Gastroenterology, Surgery Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Rubens A
authors.initials: RA
authors.lastname: Sallum
authors.affiliation: Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Fauze
authors.initials: F
authors.lastname: Maluf-Filho
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004937:Esophageal Fistula / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011475:Prosthesis Failure / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects*; D013997:Time Factors