cqvip:Background and Study Aims: Recurrent dysphagia frequently complicates the pall iative treatment of esophageal cancer with self-expanding metal stents. Strategies for repeat interventions and subsequent outcomes have not been adequately reported to date. Patients and Methods: A total of 216 patients underwent placement of a self-expanding metal stent (Ultraflex, n = 75; Flamingo Wallstent, n = 71; Z-stent, n = 70) for mali gnant dysphagia, and were followed up prospectively. The causes of stent-relate d recurrent dysphagia, the intervals after first stent placement, and the proced ures used for repeat intervention and their outcomes were evaluated. Results: Se venty-four episodes of stent-related recurrent dysphagia occurred in 63 patien ts (29%), mainly due to tumor overgrowth (n = 30; median 129 days), stent migra tion (n = 26; median 92 days) and food bolus obstruction (n = 16; median 80 days ). Stent migration occurred more frequently (P = 0.05),whereas tumor overgrowth occurred less frequently (P = 0.05) with Ultraflex stents in comparison with Fla mingo Wallstents and Z-stents. Tumor overgrowth was treated in 25 patients main ly by a second stent (n = 19) and was effective in 23 of the 25 patients (92%). Five patients received no further treatment. Stent migration was treated by pla cing a second stent (n = 14), repositioning the migrated stent (n = 7), other tr eatments (n = 3), or no further treatment (n = 2), and treatment was effective i n 20 of 24 (83%) patients. Food bolus obstruction was treated by endoscopic ste nt clearance in all patients. Repeat intervention for stent-related recurrent d ysphagia improved the dysphagia score from a median of 3 to 1 (P < 0.001). The m edian survival period after repeat treatment was 68 days. Conclusions: Recurrent dysphagia occurs in almost one-third of patients after stent placement. Repeat interventions for stent-related recurrent dysphagia are effective in over 90% of patients. New innovations in stent design are needed to reduce the risk of st ent-related recurrent dysphagia.
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