Alessandro Repici1, Manol Jovani2, Cesare Hassan2, Biagio Solito3, Roberto Di Mitri4, Federico Buffoli5, Giovanni Macrì6, Diego Fregonese7, Vincenzo Cennamo8, Mario De Bellis9, Andrea Anderloni2, Peter D Siersema10. 1. Humanitas Research Hospital, Rozzano, Milan, Italy. Electronic address: alessandro.repici@humanitas.it. 2. Humanitas Research Hospital, Rozzano, Milan, Italy. 3. Santa Chiara Hospital, Pisa, Italy. 4. Civic Hospital, Palermo, Italy. 5. Cremona Hospital, Cremona, Italy. 6. Acireale Hospital, Acireale, Italy. 7. Camposampiero Hospital, Italy. 8. S. Orsola-Malphigi Hospital University of Bologna, Bologna, Italy. 9. National Cancer Institute, G. Pascale Foundation - IRCCS, Naples, Italy. 10. University Medical Center Utrecht, Utrecht, Netherlands.
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.
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: Jan Persson; Ulrika Smedh; Åse Johnsson; Bo Ohlin; Magnus Sundbom; Magnus Nilsson; Lars Lundell; Berit Sund; Erik Johnsson Journal: Surg Endosc Date: 2017-02-24 Impact factor: 4.584