PLASTIC PROSTHESIS VERSUS EXPANDABLE METAL STENTS FOR PALLIATION OF INOPERABLE ESOPHAGEAL THORACIC CARCINOMA - A CONTROLLED PROSPECTIVE-STUDY

Background: Rapid palliation of malignant dysphagia is usually possibl e with endoscopic implantation of a plastic prosthesis, but this devic e has a high rate of complications. Recently, expandable metal stents, a new class of endoprosthesis, have become available and may reduce c omplication rates. Methods: Thirty nine patients affected by esophagea l thoracic cancer were randomly assigned to treatment with either a pl astic stent (20 patients) or expandable metal stent (19 patients). The degree of palliation (expressed as dysphagia score) and incidence of complications (short- and long-term) were compared in both treatment g roups. Results: Technical success, as a percentage of successful intub ation, was similar in both treatment groups (90% vs 94.7%, p = NS) and dysphagia scores improved. significantly and similarly in both treatm ent groups. Nevertheless, complications and mortality related to impla ntation were significantly less frequent with metal stents than with p lastic prostheses (complications: 0% vs 21%, p < 0.001; mortality: 0% vs. 15.8%, p < 0.001). Late complications included obstruction by food in both treatment groups (four cases with plastic stents vs four case s with metal stents), tube migration only with plastic prostheses (two cases) and tumor ingrowth only with metal stents (two cases). Conclus ions: Expandable metal stents can be considered an effective and safer alternative to conventional plastic prostheses in the treatment of es ophageal obstruction caused by inoperable cancer.