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Previous Volume 329:1302-1307 October 28, 1993 Number 18 Next

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ABSTRACT

Background Esophageal obstruction due to cancer can produce debilitating dysphagia. Rapid palliation is usually possible with endoscopic placement of a plastic esophageal prosthesis, but this device has a high rate of complications. A new alternative is a metal-mesh stent that collapses to 3 mm in diameter at placement but can then expand up to 16 mm.

Methods Patients with esophageal carcinoma (39 patients) or malignant extrinsic obstruction (3 patients) were randomly assigned to treatment with either a plastic prosthesis (16 mm in diameter) or an expansile metal-mesh stent. The patients were evaluated every six weeks until death. The degree of palliation was expressed as a dysphagia score and a Karnofsky performance score.

Results Complications were significantly less frequent with the metal stents than with the plastic prostheses (no complications vs. nine; P<0.001). The dysphagia and Karnofsky scores improved significantly and to a similar degree in both treatment groups. The most common causes of recurrent dysphagia were migration of the plastic prostheses (five patients) and ingrowth or overgrowth of the metal stents by tumor (five patients). The rates of reintervention were similar in both treatment groups, as were the 30-day mortality rates. The period of hospitalization after placement of a prosthesis was significantly longer in the group given plastic prostheses than in the group given metal stents (mean ±SE, 12.5 ±2.1 vs. 5.4 ±1.0 days; P = 0.005). Despite their higher initial cost, the metal stents were cost effective because of the absence of fatal complications and the decrease in the hospital stay.

Conclusions Expansile metal stents are a safe and cost-effective alternative to conventional plastic endoprostheses in the treatment of esophageal obstruction due to inoperable cancer.

Source Information

From Medizinische Klinik I (K.K.) and the Institut fur Rontgendiagnostik (H.-J.W.), Stadtische Kliniken, Kassel, Germany; Innere Abteilung IV, Krankenhaus Neukolln, Berlin, Germany (N.B.); the Medizinische Klinik, Kreiskrankenhaus, Bad Hersfeld, Germany (M.K.); and the University of Rochester Medical Center, Rochester, N.Y. (N.V.). Presented in part at the plenary session of the American Society of Gastrointestinal Endoscopy, Boston, May 19, 1993.

Address reprint requests to Dr. Knyrim at Med. Klin. I., Stadt. Kliniken, Monchebergstr. 41, 3500 Kassel, Germany.

Full Text of this Article

Related Letters:

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