Comparison of complications of self-expanding metal and conventional esophageal prostheses: 7 year experience

R. M. Bashir, D. E. Fleischer, S. W. Fry, A. M. Axclrad, F. H. Al-Kawas, S. B. Benjamin

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Abstract

Background: Expandable metal esophageal prosthescs (EMP) are considered easier to deploy than conventional plastic prostheses (CPP). however, data companng complications are limited. We reviewed our 7 year experience comparing plastic and metal stents for palliation of inoperable malignant esophageal stenoses. Methods: All patients who underwent successful esophageal stent placement between 11/87 and 11/95 were reviewed Data collection included patient demographics, stent type, stent-related complications (cpx), and ability to occlude a tracheoesophageal (TE) fistula. All complications had been prospectively recorded and evaluated at monthly QA meetings Results 96 patients (68 M. 28F, mean= 67.2y) underwent 118 esophageal stent placements (95 CPP (Wilson-Cook 74,Bard 14,Key-Med 7); 23 EMP (Z. H.Wallstent 6,Ultrailex 2,Esophacoil 1)) for malignant obstruction (99 Esoph CA, 4 Lung CA) Initial stent deployment was unsuccessful in 6 patients (6%) Stent-related chest pain occurred in 8/23 (35%) EMP and 2 (2%) CPP. Other complications requiring medical therapy, including arrhythmias, aspiration, pneumothorax, bleeding, and skin laceration were similar for CPP and EMP See table for complication data. EMP (n=23) CPP (n=95) p-value ALL Complications (Cpx) 18 (78%) 46 (48%) p< 05 1) Requiring medical therapy 11 (48%) 7 (7%) p< 01 2) Stent migration (<24 h) 4 (17%) 4 (4%) NS (>24h) 4 (17%) 20 (21%) NS -requiring add'l stent/EGD 7 (30%) 14 (15%) NS 3) Tumor ingrowth 10 (43%) 6 (6%) p< .001 4) Perforation 1 (4%) 5 (5%) NS 5) Stent-related death 1 (4%) 2 (2%) NS TE fistula occlusion 3/3 (100%) 11/14 (79%) NS Conclusions: 1) Overall, complications occured more frequently in patients with EMP than CPP (p<.05). 2) Tumor ingrowth was more common in patients with EMP than CPP (p<.01). 3) Stent-related chest pain was more common in patients EMP than CPP (p<.001). 4) The incidence of stent migration, additional stent placement, perforation, and stent-related deaths were similar for EMP and CPP. 4) CPP and coated EMP are similarly effective in the management of TE fistula.

Original languageEnglish (US)
Number of pages1
JournalGastrointestinal endoscopy
Volume43
Issue number4
DOIs
StatePublished - Jan 1 1996

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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