Gastrointestinal endoscopy · 2026
Comparison of fully covered self-expandable metal stents and liquid nitrogen spray cryotherapy for malignant esophageal disease: a retrospective cohort study.
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Moond Vishali, Khan Arsalan, Maan Soban, Byale Anjali, Elfert Khaled, Krafft Matthew, Singh Shailendra, Thakkar Shyam
Аннотация
BACKGROUND AND AIMS: Both fully covered self-expandable metal stents (FCSEMSs) and liquid nitrogen spray cryotherapy with balloon dilation (LNSC) (cryodilation) are established modalities for palliating malignant esophageal disease. FCSEMSs offer immediate luminal patency, while LNSC provides noncontact tissue ablation. Comparative data on clinical efficacy and safety are limited. We aimed to compare outcomes between FCSEMSs and LNSC in patients with esophageal malignancy.
METHODS: We conducted a retrospective cohort study of patients undergoing either FCSEMS placement (n = 131) or cryodilation (n = 38) for malignant esophageal obstruction. Clinical data included demographics, lesion characteristics, comorbidities, technical and clinical outcomes, and adverse events. Technical success was defined as successful completion of the intended procedure. Clinical success was defined as improvement or stabilization of dysphagia (Ogilvie scale), with preprocedural and postprocedural scores recorded. A sensitivity analysis restricted improvement to ≥1-point Ogilvie score change. We classified adverse events by type, timing (early ≤14 days vs late 15-30 days), and American Society for Gastrointestinal Endoscopy Lexicon severity. We used multivariable logistic regression and a propensity score sensitivity analysis to adjust for lesion location, comorbidities, disease stage, and prior therapy. We restricted a subgroup analysis to distal esophageal/gastroesophageal junction lesions.
RESULTS: Technical success was achieved in 100% of cases in both groups. Clinical success was observed in 86.8% of patients who had undergone LNSC versus 71.0% in patients with FCSEMSs (P = .057; OR, 2.70; 95% CI, 0.93-7.83). Median Ogilvie dysphagia score improved from 3 to 2 in FCSEMSs (change -1; IQR, 0 to -2) and from 3 to 1 in LNSC (change -2; IQR, -1 to -2). Adverse events were significantly more common in the FCSEMS group (31.3% vs 7.9%; P= .037; aOR, 0.21; 95% CI, 0.06-0.76 favoring LNSC). In the FCSEMS cohort, stent migration (19.1%) and intolerance requiring removal (7.6%) were the most frequent events, predominantly early (≤14 days). Minor bleeding (1.5%), tissue overgrowth (1.5%), and food impaction (1.5%) were infrequent. No perforations occurred in either group. In LNSC, 3 patients (7.9%) developed delayed stricture (late events). All adverse events were managed endoscopically.
CONCLUSIONS: In this retrospective study, both FCSEMSs and cryodilation are effective palliative options for malignant esophageal obstruction. Cryodilation was associated with fewer adverse events, whereas clinical success rates were comparable. Both modalities have distinct roles in a multidisciplinary palliative strategy, and prospective studies are needed to guide patient selection.
METHODS: We conducted a retrospective cohort study of patients undergoing either FCSEMS placement (n = 131) or cryodilation (n = 38) for malignant esophageal obstruction. Clinical data included demographics, lesion characteristics, comorbidities, technical and clinical outcomes, and adverse events. Technical success was defined as successful completion of the intended procedure. Clinical success was defined as improvement or stabilization of dysphagia (Ogilvie scale), with preprocedural and postprocedural scores recorded. A sensitivity analysis restricted improvement to ≥1-point Ogilvie score change. We classified adverse events by type, timing (early ≤14 days vs late 15-30 days), and American Society for Gastrointestinal Endoscopy Lexicon severity. We used multivariable logistic regression and a propensity score sensitivity analysis to adjust for lesion location, comorbidities, disease stage, and prior therapy. We restricted a subgroup analysis to distal esophageal/gastroesophageal junction lesions.
RESULTS: Technical success was achieved in 100% of cases in both groups. Clinical success was observed in 86.8% of patients who had undergone LNSC versus 71.0% in patients with FCSEMSs (P = .057; OR, 2.70; 95% CI, 0.93-7.83). Median Ogilvie dysphagia score improved from 3 to 2 in FCSEMSs (change -1; IQR, 0 to -2) and from 3 to 1 in LNSC (change -2; IQR, -1 to -2). Adverse events were significantly more common in the FCSEMS group (31.3% vs 7.9%; P= .037; aOR, 0.21; 95% CI, 0.06-0.76 favoring LNSC). In the FCSEMS cohort, stent migration (19.1%) and intolerance requiring removal (7.6%) were the most frequent events, predominantly early (≤14 days). Minor bleeding (1.5%), tissue overgrowth (1.5%), and food impaction (1.5%) were infrequent. No perforations occurred in either group. In LNSC, 3 patients (7.9%) developed delayed stricture (late events). All adverse events were managed endoscopically.
CONCLUSIONS: In this retrospective study, both FCSEMSs and cryodilation are effective palliative options for malignant esophageal obstruction. Cryodilation was associated with fewer adverse events, whereas clinical success rates were comparable. Both modalities have distinct roles in a multidisciplinary palliative strategy, and prospective studies are needed to guide patient selection.