TREATMENT OF MALIGNANT ESOPHAGEAL OBSTRUCTIONS WITH COVERED METALLIC Z-STENTS - LONG-TERM RESULTS IN 52 PATIENTS

PURPOSE: To prospectively evaluate the clinical efficacy of silicone-c overed Gianturco-Rosch self-expandable Z (GRZ) stents in the treatment of malignant esophageal obstruction. PATIENTS AND METHODS: G;RZ stent s were placed in 52 patients (39 men, 13 women) with severe dysphagia due to high-grade malignant esophageal obstruction. RESULTS: Stent pla cement was technically successful, and immediate relief of dysphagia w as achieved in 50 of 52 patients (96%), with long-term relief in 47 pa tients (90%), Fifty-one patients (98%) died during follow-up (range, 1 week to 33 months; mean, 4.3 months), Late complications were most pr evalent and included stent migration (n = 5), food impaction (n = 2), chest pain (n = 2), membrane disruption with tumor ingrowth (n = 1), g ranulomatous reaction above the stent (n = 1), esophageal perforation with mediastinitis (n = 1), and upper gastrointestinal hemorrhage (n = 4), Twelve complications were easily managed with medical, endoscopic , or radiologic intervention, Four deaths may have been related to ste nt placement (early mortality rate, 7.7%). CONCLUSION: GRZ stents prov ide relatively safe and effective long-term palliation in patients wit h severe, malignant esophageal obstruction.