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

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.