A new partially covered metal stent for palliation of malignant dysphagia: a prospective follow-up study.

摘要

BACKGROUND: Metal stents are frequently used for palliation of malignant dysphagia. Recently, a new stent design, the partially covered Wallflex stent (Boston Scientific, Natick, Mass), has been introduced. OBJECTIVE: To determine clinical effectiveness and safety of the esophageal Wallflex stent for the palliation of dysphagia. DESIGN: A prospective follow-up study evaluating a new stent design. SETTING: Three tertiary-care referral centers. PATIENTS: This study involved 37 patients with cancer of the esophagus or gastric cardia. INTERVENTIONS: Stent placement. MAIN OUTCOME MEASUREMENTS: Data were collected regarding technical and clinical outcome, complications, recurrent dysphagia, and survival. RESULTS: A total of 37 patients (median age, 67 years; range, 48-84 years; 22 men [59%]) had a Wallflex stent placed. Stent placement was technically successful in all but 1 patient. Dysphagia improved from a median dysphagia score of 3 (ability to swallow liquids only) to 1 (ability to eat some solid foods) 4 weeks after stent placement. Major complications occurred in 3 patients (8%; pneumonia in 1, severe pain in 2), and 1 patient (3%) died from a complication (pneumonia). Minor complications included mild retrosternal pain in 10 patients (27%) and regurgitation in 7 patients (19%). In total, 8 patients (22%) developed recurrent dysphagia because of stent migration (n = 2 [6%]), food impaction (n = 2 [6%]), or tissue ingrowth or overgrowth (n = 4 [10%]). LIMITATIONS: Nonrandomized study design. CONCLUSIONS: Placement of a partially covered Wallflex stent is safe and effective for the palliation of malignant dysphagia, with migration and tissue in- and overgrowth rates comparable to those of similarly designed stents. Retrosternal pain may occur more often with this stent than with other stent designs.