Z Gastroenterol 2009; 47 - P241
DOI: 10.1055/s-0029-1241491

Outcome of covered esophageal stents for the palliation of malignant dysphagia: Long-term results from the Ludwigshafen esophageal cancer register

A Eickhoff 1, 2, C Schlott 3, J Striegel 3, JC Eickhoff 4, JF Riemann 3, R Jakobs 3
  • 1Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Interdisziplinäre Endoskopie, Hamburg, Germany
  • 2Klinikum Ludwigshafen, Medizinische Klinik C, Ludwigshafen, Germany
  • 3Klinikum Ludwigshafen, Ludwigshafen, Germany
  • 4University of Wisconsin, Department of Biostatistics and Medical Informatics, Madison, United States

Aims: Different types of covered metal stents are currently available for palliation of patients with malignant dysphagia. Data of their advantages and disadvantages are based on results from previously published prospective trials.

Aim/methods: To evaluate efficacy and outcome of 4 different types of covered metal/plastic stents in malignant dysphagia. Prospective trial of 269 consecutive patients (pts.) with malignant dysphagia due to esophagogastric cancer. We used 4 types of covered esophageal stents (group A: Gianturco Z stent n=61 pts.; group B: Ultraflex stent n=103 pts.; group C: Flamingo Wallstent n=68 pts.; group D Polyflex stent n=37 pts.). There were 66 female and 203 male with a median age of 64.6 (range 43–94) years. Pre- and post-stent dysphagia symptoms were graded on a scale from 0 to 4 (0=normal swallowing to 4=cannot swallow own saliva). The 4 stent groups were compared for improvement of dysphagia score, survival, recurrent dysphagia, Karnofsky-performance-score (KPS), and complications.

Results: Primary stent placement was successful in 56/61 (92%) pts. of group A, 99/103 (96%) of group B, 65/68 (95%) of group C and 32/37 (86%) pts of group D. Median hospital stay after implantation was 4.1 days (group A), 3.2 days (group B), 3.5 days (group C) and 5.2 days (group D) (p=0.23). At 2 to 4 weeks after stenting, median dysphagia score improved in group A (from 2.77 to 0.99), group B (from 2.68 to 0.72), group C (from 2.62 to 0.81) and group D (2.99 to 0.92). There was no significant difference between the groups (p=0.37). Median survival after insertion was 96 days (group A), 118 days (group B), 108 days (group C) and 102 days (group D) (p=0.18). Major complications were seen in 21/61 (34%) pts. of group A, 17/103 (16%) pts. of group B, 11/68 (17%) pts. of group C and 14/37 (37%) pts. of group D (p=0.04). Migration occurred significantly more often in group D (24%).

Conclusion: All 4 types of covered stents evaluated in the study offer the same degree of palliation of patients with malignant dysphagia. However, insertion of Gianturco-Z stents and Polyflex stents seems to be associated with more major complications. Overall, the „perfect“ esophageal stent for palliation of malignant dysphagia has not been found until today.