Abstract
Purpose
To evaluate the long-term clinical outcomes and the negative predictors after the deployment of double-layered stents in malignant esophageal strictures.
Methods
This is a single-center study of patients who received a double-layered covered stent for the palliation of dysphagia due to malignant esophageal strictures in a 3-year period. 56 patients fulfilled the inclusion criteria. The study’s primary end points were technical success, dysphagia improvement, stent migration, and complication rates; secondary end points were the stent’s primary patency and overall survival. Cox regression analysis was used to adjust for confounding variables and to identify predictors of survival outcomes.
Results
Technical success was 95 %. Median dysphagia score improved significantly after stenting (p < 0.0001). Stent migration rate was 7.1 % and occurred exclusively in the group of patients who received chemoradiotherapy (p < 0.01). The median stent patency was 87 days (range 5–444 days). Dysphagia reoccurred in 39.3 % and was successfully managed with restenting in 98.2 %. The median survival was 127 days (range 15–1480 days). Chemoradiotherapy and baseline histology did not influence survival outcomes. Survival was adversely affected by metastases (p = 0.005) and poor oral intake (p = 0.048). Patient survival was improved by repeat stenting in case of tissue overgrowth (p = 0.06).
Conclusion
The device is safe and effective for the treatment of patients with dysphagia due to esophageal cancer. Migration rate is zero for patients who do not receive chemoradiotherapy. Reintervention when required is a positive survival predictor.
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References
Katsanos K, Sabharwal T, Adam A (2010) Stenting of the upper gastrointestinal tract: current status. Cardiovasc Intervent Radiol 33:690–705
Javle M, Ailawadhi S, Yang GY et al (2006) Palliation of malignant dysphagia in esophageal cancer: a literature-based review [review]. J Support Oncol 4:365–373
Siersema PD (2008) Treatment options for esophageal strictures. Nat Clin Pract Gastroenterol Hepatol 5:142–152
Schembre D (2010) Advances in esophageal stenting: the evolution of fully covered stents for malignant and benign disease. Adv Ther 27:413–425
Sabharwal T, Morales JP, Irani FG, Adam A (2005) Quality improvement guidelines for placement of esophageal stents. Cardiovasc Intervent Radiol 28:248–288
Verschuur EM, Homs MY, Steyerberg EW et al (2006) A new esophageal stent design (Niti-S stent) for the prevention of migration: a prospective study in 42 patients. Gastrointest Endosc 63:134–140
Kim ES, Jeon SW, Park SY et al (2009) Comparison of double-layered and covered Niti-S stents for palliation of malignant dysphagia. J Gastroenterol Hepatol 24:114–119
Park JG, Jung GS, Oh KS, Park SJ (2010) Double-layered PTFE-covered nitinol stents: experience in 32 patients with malignant esophageal strictures. Cardiovasc Intervent Radiol 33:772–779
Choi SJ, Kim JH, Choi JW et al (2011) Fully covered, retrievable self-expanding metal stents (Niti-S) in palliation of malignant dysphagia: long-term results of a prospective study. Scand J Gastroenterol 46:875–880
Sabharwal T, Irani FG, Adam A (2007) Quality assurance guidelines for placement of gastroduodenal stents. Cardiovasc Intervent Radiol 30:1–5
Morgan R, Adam A (2001) Use of metallic stents and balloons in the esophagus and gastrointestinal tract. J Vasc Interv Radiol 12:283–297
Wang MQ, Sze DY, Wang ZP et al (2001) Delayed complications after esophageal stent placement for treatment of malignant esophageal obstructions and esophagorespiratory fistulas. J Vasc Interv Radiol 12:465–474
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Mezes, P., Krokidis, M.E., Katsanos, K. et al. Palliation of Esophageal Cancer with a Double-layered Covered Nitinol Stent: Long-term Outcomes and Predictors of Stent Migration and Patient Survival. Cardiovasc Intervent Radiol 37, 1444–1449 (2014). https://doi.org/10.1007/s00270-013-0829-2
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DOI: https://doi.org/10.1007/s00270-013-0829-2