Document Detail


Are metal stents effective for palliation of malignant dysphagia and fistulas?
MedLine Citation:
PMID:  12801040     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: One of the available treatments for unresectable oesophagogastric malignancies is the insertion of metal stents. AIMS: We evaluated prospectively 147 patients suffering from malignant dysphagia and/or fistula, after inserting a self-expandable metal stent. PATIENTS AND METHODS: The study included 147 patients (87 males, mean age 73 years). Dysphagia before and after stent placement was scored. Patients were divided in two groups according to dysphagia grade: group A (grade 0, 1) and group B (grades 2, 3, 4). Three types of stents were used: the Ultraflex stent (covered and uncovered) and the Flamingo one (covered). The total number of self-expandable metal stents placed was 183. A total of 92 of them were inserted following the combined endoscopic and fluoroscopic approach (42 by injecting lipiodol), while 91 were placed under endoscopic control only. Early and late complications were evaluated. RESULTS: Mean dysphagia score in group A, 1 day and 1 month after the procedure, was slightly reduced from 0.8 to 0.5/0.6 (p=NS), respectively. However, there was a statistically significant improvement (p<0.001) of mean dysphagia score in group B, from 2.4 initially to 1.1/1.4. Early complications occurred in 37 cases, late ones in 51. According to severity, minor complications occurred in 24 patients, major in 42, while life-threatening ones in 22. Survival ranged from 1 to 611 days and 1-week mortality was 9%. Stent-related death occurred in six patients. CONCLUSIONS: All kinds of endoscopic methods used for stenting in the present study were easy to perform even on an out-patient basis. Insertion of self-expandable metal stents is effective in patients with dysphagia scores > or = 2. It might not clinically improve patients with dysphagia score <2, so selection of patients for stenting is essential to avoid unnecessary procedures. Moreover, their high cost, high complication rates and low overall survival may improve following better selection criteria.
Authors:
P P Kostopoulos; M I Zissis; A A Polydorou; P P Premchand; M T Hendrickse; C J Shorrock; P E T Isaacs
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver     Volume:  35     ISSN:  1590-8658     ISO Abbreviation:  Dig Liver Dis     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-06-12     Completed Date:  2003-07-31     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  100958385     Medline TA:  Dig Liver Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  275-82     Citation Subset:  IM    
Affiliation:
Gastroenterology Unit, Blackpool Victoria Hospital, Blackpool FY3 8NR, UK.
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MeSH Terms
Descriptor/Qualifier:
Adenocarcinoma / complications
Adult
Aged
Aged, 80 and over
Carcinoma, Squamous Cell / complications
Deglutition Disorders / classification,  etiology,  therapy*
Esophageal Fistula / etiology,  therapy*
Esophageal Neoplasms / complications
Female
Humans
Male
Middle Aged
Palliative Care / methods*
Prospective Studies
Stents* / adverse effects
Survival Analysis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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