BACKGROUND: In this prospective study a consecutive series of 70 patients undergoing insertion of a Wilson-Cook endoprosthesis for palliation of esophageal carcinoma was examined. METHODS: The tube was inserted endoscopically using intravenous sedation and a pulsion technique. RESULTS: The patients had a mean (SEM) age of 70.7 (1.5) years and 44 (63%) were men. Two patients died in hospital and 2 died after discharge, giving a procedure-related mortality of 2.8% and a 30-day mortality of 5.7%. Nine patients experienced complications, giving a morbidity rate of 12.8% following the initial procedure. Twenty patients required a second or further procedure. The indications were tube migration in 22 cases, obstruction in 10, and fistula formation in 2 patients. Thirty-day mortality in this group was significantly greater than after a first procedure (7 patients, 20.1%; P <0.05). The median survival following insertion of a Wilson-Cook endoprosthesis was 16 weeks. CONCLUSIONS: This study describes a safe, effective method for insertion of an endoprosthesis, with a low morbidity and mortality. The average cost for endoscopic insertion of a Wilson-Cook endoprosthesis in this unit is $1,600, and in view of the short median survival in this group of patients, the introduction of costly self-expanding stents is not warranted without demonstrable benefits in a controlled, prospective, randomized clinical trial.
RCT Entities:
BACKGROUND: In this prospective study a consecutive series of 70 patients undergoing insertion of a Wilson-Cook endoprosthesis for palliation of esophageal carcinoma was examined. METHODS: The tube was inserted endoscopically using intravenous sedation and a pulsion technique. RESULTS: The patients had a mean (SEM) age of 70.7 (1.5) years and 44 (63%) were men. Two patients died in hospital and 2 died after discharge, giving a procedure-related mortality of 2.8% and a 30-day mortality of 5.7%. Nine patients experienced complications, giving a morbidity rate of 12.8% following the initial procedure. Twenty patients required a second or further procedure. The indications were tube migration in 22 cases, obstruction in 10, and fistula formation in 2 patients. Thirty-day mortality in this group was significantly greater than after a first procedure (7 patients, 20.1%; P <0.05). The median survival following insertion of a Wilson-Cook endoprosthesis was 16 weeks. CONCLUSIONS: This study describes a safe, effective method for insertion of an endoprosthesis, with a low morbidity and mortality. The average cost for endoscopic insertion of a Wilson-Cook endoprosthesis in this unit is $1,600, and in view of the short median survival in this group of patients, the introduction of costly self-expanding stents is not warranted without demonstrable benefits in a controlled, prospective, randomized clinical trial.
Authors: Douglas Adamson; Jane Blazeby; Annmarie Nelson; Chris Hurt; Lisette Nixon; Jim Fitzgibbon; Tom Crosby; John Staffurth; Mim Evans; Noreen Hopewell Kelly; David Cohen; Gareth Griffiths; Anthony Byrne Journal: Trials Date: 2014-10-22 Impact factor: 2.279
Authors: Douglas Adamson; Jane Blazeby; Catharine Porter; Christopher Hurt; Gareth Griffiths; Annmarie Nelson; Bernadette Sewell; Mari Jones; Martina Svobodova; Deborah Fitzsimmons; Lisette Nixon; Jim Fitzgibbon; Stephen Thomas; Anthony Millin; Tom Crosby; John Staffurth; Anthony Byrne Journal: Health Technol Assess Date: 2021-05 Impact factor: 4.014