Expandable stents compared to conventional plastic endoprostheses in malignant oesophageal obstruction, especially in cardiac cancer and fistulas: the experience of the Netherlands Cancer Institute.

BACKGROUND

Advanced oesophageal carcinoma usually causes debilitating dysphagia. An endoprosthesis can offer adequate palliation. The self-expandable metal stents provide several advantages over the plastic endoprostheses: less traumatic introduction and stronger attachment to the oesophageal wall.

OBJECTIVE

To evaluate whether the self-expandable stents are more effective, especially in the technically challenging group of patients with a cardiac carcinoma or a fistula.

SETTING

A single-institution study (cancer hospital).

METHODS

A retrospective study of 132 consecutive patients (92 men and 40 women; median age 67 years) in whom a stent was inserted between 1991 and 1996. A plastic stent was applied in 72 patients, and from 1994 onwards an expandable stent in 60 subsequent patients.

RESULTS

Overall technical success rate was high for both types of stents: 93 vs 88%. Clear improvement of dysphagia occurred more often with the expandable stents (80%) compared to the plastic stents (62%). Unfortunately, loss of appetite remained a problem in 30% of the patients. In the more troublesome subgroup of cardiac carcinoma (n = 55) and (imminent) fistula (n = 42) stenting was equally effective. Early complications were significantly less often encountered for the self-expandables: 3 vs 45%, the same was true for insertion related mortality: 0 vs 10%. Also the need for reintervention was less frequent: 12 vs 23%. This was especially on the account of the plastic stent in fistulas.

CONCLUSIONS

Technical success rate was excellent for all types of stents, but in particular for the self-expandable stents which were also associated with fewer side effects. The subgroups of fistula and cardia carcinoma did equally well, probably related to adequate choice of stent.