Palliative treatment of malignant esophageal stenosis: experience with plastic versus metal stents.

Abstract

BACKGROUND/AIMS:

We report on the palliative treatment of 44 patients with malignant dysphagia by placement of plastic (Celestin tubes, n = 24) vs metal stents (Wall stents, Nitinol stents, Gianturco stents, n = 20).

METHODOLOGY:

Prior to stent insertion, esophageal stenosis was dilated stepwise to 16 mm (plastic tube) and to 10 mm (metal stent).

RESULTS:

Stent insertion was technically successful in all cases and led to a reduction of dysphagia. Risk of perforation was comparable in both groups (n = 1 in each group). Most of the plastic stents were placed when the tumor was localized in the proximal part of the esophagus close to the upper esophageal sphincter, when esophageal-bronchial fistula was present and in the risk of fistula development after radiation. During follow-up, tumor ingrowth (TI) and stent migration (SM) were the major complications. Whereas tumor ingrowth predominantly occurred in metal stents (TI after 6 weeks, 45% vs. SM, 10%) that required repeated argon beamer therapy, tube migration and bolus impaction (BI) often occurred in patients with plastic stents (TI, 0% vs. SM, 16%; BI, 4%).

CONCLUSIONS:

The findings of the study suggest that the decision whether plastic tubes or metal stents used should be taken individually considering tumor localization, axis deviation and the presence of esophago-respiratory fistulas. When stepwise dilation of malignant stenoses is performed carefully, perforation risk appears not to be different between placement of plastic prostheses and metal stents.

• Authors: B Schumacher, H Lübke, T Frieling, D Haussinger, C Niederau
• Journal: Hepato-gastroenterology (Hepatogastroenterology) 1998 May-Jun Vol. 45 Issue 21 Pg. 755-60 ISSN: 0172-6390 [Print] Greece
• PMID: 9684128 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Metals
• Plastics

Topics

• Aged
• Aged, 80 and over
• Bronchial Fistula
• Deglutition Disorders (etiology)
• Esophageal Fistula
• Esophageal Neoplasms (complications)
• Esophageal Stenosis (complications, etiology, therapy)
• Female
• Humans
• Male
• Metals
• Middle Aged
• Palliative Care
• Plastics
• Stents