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Endoscopy. 2019 Jan;51(1):18-29. doi: 10.1055/a-0644-2495. Epub 2018 Jul 10.

Self-expandable metal stent placement for malignant esophageal strictures - changes in clinical outcomes over time.

Author information

1
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
2
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
3
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
#
Contributed equally

Abstract

BACKGROUND:

Self-expandable metal stents (SEMSs) are effective for improving dysphagia in patients with incurable esophageal cancer but are also associated with recurrent dysphagia and adverse events. In the past decades, new SEMSs have been introduced, but also patients' risk profiles have altered. It is unknown if these changes have affected SEMS outcomes.

METHODS:

This retrospective cohort study was conducted in a tertiary referral center in the Netherlands. Patients who underwent palliative esophageal SEMS placement for malignant dysphagia between 1994 and 2017 were included. The primary outcome was to assess shifts over time with respect to recurrent dysphagia and adverse events after SEMS placement.

RESULTS:

997 patients who underwent SEMS placement were included. Recurrent dysphagia occurred in 309 patients (31 %) and remained stable, although with a trend towards an increase over time (hazard ratio [HR] 1.02 per 1-year increase; P = 0.05). Migration rate significantly increased over time (HR 1.04 per 1-year increase; P = 0.01). SEMS-related complications occurred in 461 patients (46.2 %), with 207 (20.7 %) major and 336 (33.7 %) minor complications. Prior chemoradiotherapy was significantly associated with major complications (HR 1.69; P < 0.001). Pain was the most common adverse event and showed a significant increase over time (P < 0.01). Factors associated with pain were prior chemoradiotherapy, absence of a fistula, axial and radial forces, and squamous cell carcinoma.

CONCLUSIONS:

Despite the introduction of novel esophageal SEMS designs, recurrent dysphagia has not declined over the years. Stent-related complications have increased in recent years, which seems to be mainly associated with more frequent use of chemoradiotherapy prior to SEMS placement.

PMID:
29991071
DOI:
10.1055/a-0644-2495

Conflict of interest statement

Prof. Bruno has received personal fees as lecturer and consultant. Reports having received institutional financial support for industry and investigator initiated studies from Boston Scientific, Cook Medical, Pentax Medical and 3M. Prof. Siersema has received research support from Ella-CS, Boston Scientific USA and Cook Medical Ireland. Dr. Spaander has received institutional financial support for investigator initiated studies from Boston Scientific. The remaining authors have no competing interests to report.

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