FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

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

	Full Text Letters Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

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:

Expansile Stents in Esophageal Cancer
Coia L. R., Ahmad N., Rosenthal S. A., Bennett J. R., Dakkak M., Vakil N., Knyrim K.
Extract | Full Text  
N Engl J Med 1994; 330:790-791, Mar 17, 1994. Correspondence

Endoscopic Palliation of Malignant Dysphagia
McCray R. S., Wong R. C.K., Van Dam J.
Extract | Full Text  
N Engl J Med 1997; 336:294-295, Jan 23, 1997. Correspondence

This article has been cited by other articles:

• Deans, D. C., Tan, B. H., Ross, J. A, Rose-Zerilli, M., Wigmore, S. J, Howell, W M., Grimble, R. F, Fearon, K. C. (2009). Cancer cachexia is associated with the IL10 -1082 gene promoter polymorphism in patients with gastroesophageal malignancy. Am. J. Clin. Nutr. 89: 1164-1172 [Abstract] [Full Text]  
• Selinger, C.P., Ellul, P., Smith, P.A., Cole, N.C. (2008). Oesophageal stent insertion for palliation of dysphagia in a District General Hospital: experience from a case series of 137 patients. QJM 101: 545-548 [Abstract] [Full Text]  
• Pennathur, A., Chang, A. C., McGrath, K. M., Steiner, G., Alvelo-Rivera, M., Awais, O., Gooding, W. E., Christie, N. A., Gilbert, S., Landreneau, R. J., Luketich, J. D. (2008). Polyflex Expandable Stents in the Treatment of Esophageal Disease: Initial Experience. Ann. Thorac. Surg. 85: 1968-1973 [Abstract] [Full Text]  
• Guo, J.-H., Teng, G.-J., Zhu, G.-Y., He, S.-C., Fang, W., Deng, G., Li, G.-Z. (2008). Self-expandable Esophageal Stent Loaded with 125I Seeds: Initial Experience in Patients with Advanced Esophageal Cancer. Radiology 247: 574-581 [Abstract] [Full Text]  
• Kagaya, H., Kitayama, J., Hidemura, A., Kaisaki, S., Ishigami, H., Takei, J., Kanazawa, T., Nagawa, H. (2007). Metastatic Esophageal Tumor from Cecal Carcinoma. Jpn J Clin Oncol 0: hym078v1-4 [Abstract] [Full Text]  
• Anderson, G. S., Levine, M. S., Rubesin, S. E., Laufer, I., Ginsberg, G. G., Kochman, M. L. (2006). Esophageal stents: findings on esophagography in 46 patients.. Am. J. Roentgenol. 187: 1274-1279 [Abstract] [Full Text]  
• Yoon, C. J., Shin, J. H., Song, H.-Y., Lim, J.-O., Yoon, H.-K., Sung, K.-B. (2004). Removal of Retrievable Esophageal and Gastrointestinal Stents: Experience in 113 Patients. Am. J. Roentgenol. 183: 1437-1444 [Abstract] [Full Text]  
• Farivar, A. S., Vallieres, E., Kowdley, K. V., Wood, D. E., Mulligan, M. S. (2004). Airway obstruction complicating esophageal stent placement in two post-pneumonectomy patients. Ann. Thorac. Surg. 78: e22-e23 [Abstract] [Full Text]  
• Ilson, D. H., Bains, M., Kelsen, D. P., O'Reilly, E., Karpeh, M., Coit, D., Rusch, V., Gonen, M., Wilson, K., Minsky, B. D. (2003). Phase I Trial of Escalating-Dose Irinotecan Given Weekly With Cisplatin and Concurrent Radiotherapy in Locally Advanced Esophageal Cancer. JCO 21: 2926-2932 [Abstract] [Full Text]  
• Sabharwal, T, Hamady, M S, Chui, S, Atkinson, S, Mason, R, Adam, A (2003). A randomised prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma. Gut 52: 922-926 [Abstract] [Full Text]  
• Allum, W H, Griffin, S M, Watson, A, Colin-Jones, D (2002). Guidelines for the management of oesophageal and gastric cancer. Gut 50 : v1-v23 [Full Text]  
• Lee, S H (2001). The role of oesophageal stenting in the non-surgical management of oesophageal strictures. Br. J. Radiol. 74: 891-900 [Abstract] [Full Text]  
• Muto, M., Ohtsu, A., Miyata, Y., Shioyama, Y., Boku, N., Yoshida, S. (2001). Self-expandable Metallic Stents for Patients with Recurrent Esophageal Carcinoma After Failure of Primary Chemoradiotherapy. Jpn J Clin Oncol 31: 270-274 [Abstract] [Full Text]  
• Christie, N. A., Buenaventura, P. O., Fernando, H. C., Nguyen, N. T., Weigel, T. L., Ferson, P. F., Luketich, J. D. (2001). Results of expandable metal stents for malignant esophageal obstruction in 100 patients: short-term and long-term follow-up. Ann. Thorac. Surg. 71: 1797-1802 [Abstract] [Full Text]  
• Baron, T. H. (2001). Expandable Metal Stents for the Treatment of Cancerous Obstruction of the Gastrointestinal Tract. NEJM 344: 1681-1687 [Full Text]  
• Nomori, H., Horio, H., Imazu, Y., Suemasu, K. (2000). Double stenting for esophageal and tracheobronchial stenoses. Ann. Thorac. Surg. 70: 1803-1807 [Abstract] [Full Text]  
• Song, H.-Y., Jung, H.-Y., Park, S.-I., Kim, S.-B., Lee, D. H., Kang, S.-G., Il Min, Y. (2000). Covered Retrievable Expandable Nitinol Stents in Patients with Benign Esophageal Strictures: Initial Experience. Radiology 217: 551-557 [Abstract] [Full Text]  
• Shimi, S.M. (2000). Self-expanding Metallic Stents in the Management of Advanced Esophageal Cancer: A Review. SURG INNOV 7: 9-21 [Abstract]  
• Dam, J. V., Brugge, W. R. (1999). Endoscopy of the Upper Gastrointestinal Tract. NEJM 341: 1738-1748 [Full Text]  
• Ilson, D. H., Saltz, L., Enzinger, P., Huang, Y., Kornblith, A., Gollub, M., O'Reilly, E., Schwartz, G., DeGroff, J., Gonzalez, G., Kelsen, D. P. (1999). Phase II Trial of Weekly Irinotecan Plus Cisplatin in Advanced Esophageal Cancer. JCO 17: 3270-3275 [Abstract] [Full Text]  
• Maier, A., Pinter, H., Friehs, G. B., Renner, H., Smolle-Juttner, F. M. (1999). Self-expandable coated stent after intraluminal treatment of esophageal cancer: a risky procedure?. Ann. Thorac. Surg. 67: 781-784 [Abstract] [Full Text]  
• Mainar, A., De Gregorio Ariza, M. A., Tejero, E., Tobío, R., Alfonso, E., Pinto, I., Herrera, M., Fernández, J. A. (1999). Acute Colorectal Obstruction: Treatment with Self-expandable Metallic Stents before Scheduled Surgery—Results of a Multicenter Study. Radiology 210: 65-69 [Abstract] [Full Text]  
• Low, D. E., Kozarek, R. A. (1998). Comparison of Conventional and Wire Mesh Expandable Prostheses and Surgical Bypass in Patients With Malignant Esophagorespiratory Fistulas. Ann. Thorac. Surg. 65: 919-923 [Abstract] [Full Text]  
• Reed, C. E. (1998). . Ann. Thorac. Surg. 65: 923-923 [Full Text]  
• Allgaier, H.-P., Schwacha, H., Technau, K., Blum, H. E. (1997). Fatal Esophagoaortic Fistula after Placement of a Self-Expanding Metal Stent in a Patient with Esophageal Carcinoma. NEJM 337: 1778-1778 [Full Text]  
• Vitale, G. C. (1997). Shape Memory Stents for Biliary and Esophageal Strictures. SURG INNOV 4: 125-131 [Abstract]  
• McCray, R. S., Wong, R. C.K., Van Dam, J. (1997). Endoscopic Palliation of Malignant Dysphagia. NEJM 336: 294-295 [Full Text]  
• Moores, D. W. O., Ilves, R. (1996). Treatment of Esophageal Obstruction With Covered, Self-Expanding Esophageal Wallstents. Ann. Thorac. Surg. 62: 963-967 [Abstract] [Full Text]  
• Fuchs, C. S., Mayer, R. J. (1995). Gastric Carcinoma. NEJM 333: 32-41 [Full Text]  
• Wong, K., Goldstraw, P. (1995). Role of Covered Esophageal Stents in Malignant Esophagorespiratory Fistula. Ann. Thorac. Surg. 60: 199-200 [Abstract] [Full Text]  
• Forgacs, I. (1995). Recent Advances: Clinical gastroenterology. BMJ 310: 113-116 [Full Text]  
• Coia, L. R., Ahmad, N., Rosenthal, S. A., Bennett, J. R., Dakkak, M., Vakil, N., Knyrim, K. (1994). Expansile Stents in Esophageal Cancer. NEJM 330: 790-791 [Full Text]  
• (1993). METAL STENT RELIEVES DYSPHAGIA IN ESOPHAGEAL CANCER. JWatch General 1993: 5-5 [Full Text]  
• Boyce, H. W. (1993). Stents for Palliation of Dysphagia Due to Esophageal Cancer. NEJM 329: 1345-1346 [Full Text]