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

作者：van Boeckel Petra G^*; Siersema Peter D; Sturgess Richard; Dwyer Laura; Raijman Isaac; Hirdes Meike M; Vleggaar Frank P

来源：Gastrointestinal Endoscopy, 2010, 72(6): 1269-1273.

DOI：10.1016/j.gie.2010.07.040

Background: Metal stems are frequently used for palliation of malignant dysphagia. Recently, a new stem design, the partially covered Wallflex stem (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 stem 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. Stem 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 stem 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 stem than with other stem designs.

• 出版日期2010-12