| A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. | |
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MedLine Citation:
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PMID: 7692297 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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K Knyrim; H J Wagner; N Bethge; M Keymling; N Vakil |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The New England journal of medicine Volume: 329 ISSN: 0028-4793 ISO Abbreviation: N. Engl. J. Med. Publication Date: 1993 Oct |
Date Detail:
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Created Date: 1993-11-01 Completed Date: 1993-11-01 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1302-7 Citation Subset: AIM; IM |
Affiliation:
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Medizinische Klinik I, St?dtische Kliniken, Kassel, Germany. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cost-Benefit Analysis Deglutition Disorders / etiology Esophageal Neoplasms / complications* Esophageal Stenosis / etiology, therapy* Female Follow-Up Studies Humans Male Metals Middle Aged Palliative Care* Plastics Prosthesis Design Recurrence Stents* / economics Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Metals; 0/Plastics |
| Comments/Corrections | |
Comment In:
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N Engl J Med. 1993 Oct 28;329(18):1345-6
[PMID:
7692298
]
N Engl J Med. 1994 Mar 17;330(11):790; author reply 790-1 [PMID: 7509035 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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