Z Gastroenterol 2016; 54 - KV079
DOI: 10.1055/s-0036-1586855

A prospective trial comparing two types of self-expanding stents in the palliation of malignant dysphagia: SEMS (Wallflex stent) versus SEPS (Polyflex stent)

N Grabmann 1, A Genthner 1, F Straulino 1, A Schwarzenböck 1, JC Eickhoff 2, A Eickhoff 1
  • 1Klinikum Hanau, Medizinische Klinik II, Hanau, Deutschland
  • 2University of Wisconsin, Department of Biostatistics and Medical Informatics, Madison, USA

Background: High-grade dysphagia is the predominant late symptom of local advanced esophagogastric cancer. Malignant dysphagia due to such cancers results in much patient morbidity and is associated with poor overall prognosis. Placement of self-expandable metal stents (SEMS) is an established method of treatment for inoperable esophagogastric cancers. A self-expandable plastic stent (SEPS) has been developed recently.

Aim/Methods: To evaluate efficacy and outcome of a special type of SEMS (Wallflex stent) versus the newly designed SEPS (Polyflex stent). Prospective randomized trial of 60 patients (pts.) with malignant dysphagia; 30 pts. received a SEMS and 30 pts. a SEPS. There were 23 females and 37 males with a median age of 70.3 (range 32 – 80) years. Pre- and post-stent dysphagia symptom was graded on a scale from 0 to 4 (0 = normal swallowing, 1 = dysphagia for solids only, 2 = dysphagia for semi-solids also, 3 = dysphagia for liquids also, 4 = cannot swallow own saliva). Wallflex stents (SEMS) and Polyflex stents (SEPS) were compared for improvement of dysphagia score, survival, recurrent dysphagia, Karnofsky-performance-score (KPS) and complications.

Results: Primary stent placement was successful in 30/30 (100%) pts. in the SEMS group and 29/30 (97%) pts. of the SEPS group. Median hospital stay after implantation was 2.9 days (SEMS) and 3.7 days (SEPS)(p = 0.48). After 1 and 4 weeks after stenting, median dysphagia score improved in the SEMS group (from 3.15 to 1.23) and the SEPS group (from 2.84 to 1.26), the improvement without significant difference between both groups (p = 0.28). Duration of improvement of dysphagia was 85 days (SEMS) and 61 days (SEPS) (p = 0.09). Recurrrent dysphagia was noted in 8/30 (27%) pts. with SEMS and 13/30 (43%) of pts. with SEPS (p = 0.02). Median survival after insertion of the stent was 201 days (SEMS) and 180 days (SEPS). Mean KPS increased from 66 to 76 (SEMS) and 68 to 77 (SEPS). Migration of the stent was seen significantly (p = 0.01) more often in the SEPS group than in the SEMS group (28% vs. 4%).

Conclusion: Our results indicate a potential benefit for SEMS versus the specially designed SEPS in malignant dysphagia in the long run. SEMS seems to be safer and related with a prolonged improvement of dysphagia-score.