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Self-Expanding Metal Stents Versus Plastic Prostheses in the Palliation of Malignant Dysphagia: Long-term Outcome of 153 Consecutive Patients

Eickhoff, Axel MD*; Knoll, Matthias MD*; Jakobs, Ralf MD*; Weickert, Uwe MD*; Hartmann, Dirk MD*; Schilling, Dieter MD*; Eickhoff, Jens C PhD; Riemann, Jürgen F MD*

Journal of Clinical Gastroenterology: November-December 2005 - Volume 39 - Issue 10 - p 877-885
doi: 10.1097/01.mcg.0000180631.61819.4a
Alimentary Tract: Clinical Research
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Background: Malignant dysphagia due to esophagogastric cancer is associated with poor overall prognosis. Placements of self-expandable metal stents or plastic tubes are established methods as palliative treatment options. As an alternative and/or complementary therapy, radiologic techniques (external beam radiation/brachytherapy) and locally endoscopic techniques (laser, APC-beamer, PDT) are often used.

Study and Goals: Retrospective trial of 153 patients treated in our department between 1993 and 2001. Forty-five patients received a plastic tube (Group A) and 108 patients were treated with metal stents (Group B). Both groups were compared for improvement of dysphagia score, survival, recurrent dysphagia and complications.

Results: Stent placement was successful in 41 of 45 (93%) patients of Group A and 107 of 108 (99%) of Group B. The median dysphagia score improved significantly in Group A (from 3.03 to 1.55, P = 0.010) and Group B (from 2.77 to 1.44, P = 0.009). Recurrent dysphagia was noted in 12 of 45 (27%) patients of Group A and 27 of 108 (25%) patients of Group B. Median survival time after stent insertion was 78 days (Group A) and 113 days (Group B). Overall complications occurred in 15 of 45 (33%) patients of Group A and 28 of 108 (26%) patients of Group B. However, significantly (P = 0.05) more major complications were seen in Group A than in Group B (22% vs. 9%).

Conclusions: Our results indicate a marginal clinical benefit for metal stents versus plastic tubes in malignant dysphagia in the long run. However, metal stents seem to be safer and associated with a prolonged improvement of dysphagia score.

From the *Medical Department C, Klinikum Ludwigshafen, Ludwigshafen, Germany; and †Department of Biostatistics & Medical Informatics, University of Wisconsin, Madison, WI.

Received for publication January 13, 2005; accepted April 6, 2005.

Presented in part at the Annual Meeting of the American Gastroenterological Association, Orlando, FL, May 19-22, 2003.

Reprints: Axel Eickhoff, MD, Medical Department C, Klinikum Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany (e-mail: eickhofa@klilu.de).

© 2005 Lippincott Williams & Wilkins, Inc.