Subramanian, S.; Hine, K.R.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA43
Academic Journal
Background: Oesophageal carcinoma is a largely incurable disease The main aim of palliation is to restore oesophageal patency. Current oesophageal endoprostheses comprise semirigiaplastic stents and self-expandable metal stents (SEMS. In recent years, prospective randomised controlled trials have demonstrated a higher efficacy and a lower complication and mortality rate (0 v 15.8%) for SEMS v plastic stents. Aims: We reviewed our experience with the efficacy, safety and complications with stents placed for palliation of malignant dysphagia. Materials and Methods: The case notes of all patients that had a stent inserted between 1985 and 2002 were reviewed. Data including demographics, type of stent, dysphagia score prior to after implantation of stent, complications and survival were recorded on a database. Results: A total of 120 stents were implanted during the study period. We used the conventional Atkinson plastic prosthesis and four different types of SEMS: Z-stent (N=22), b-stent (N=21), Uncovered wall stent (N=5) and Choo stent (N=4). Complications were divided into immediate (<1 week) and delayed (>1 week), following stent insertion. Immediate complications for all stents in our series included chest pain - 1(0.8%), failure to deploy stent - 1 (0.8%), perforation - 8 (6.7%), stent displacement - 4 (3.3%) and death - 1 (0.8%), resulting from the procedure. Delayed complications for all stents included stent displacement - 10(8.3%), recurrent dysphagia - 10 (8.3%), food impaction - 3 (2.5%), broncho-oesophogeal fistuala formation - 4 (3.3%), bleeding - 5 (4.2%) and tumour ingrowth/ overgrowth - 4 (3.3%). Conclusions: Both immediate and delayed complication rates were higher n the plastic endoprostheses group. The complication rates are similar to previously reported series. In conclusion, SEMS are a safer and efficacious mode of palliation for oesophageal carcinoma. However, there is no added survival benefit in this group.


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