EXPANDABLE VERSUS CONVENTIONAL ESOPHAGEAL PROSTHESES - EASIER INSERTION MAY NOT PRECLUDE SUBSEQUENT STENT-RELATED PROBLEMS

Background: Although expandable esophageal endoprostheses may be easie r to insert and are associated with fewer procedure-related perforatio ns, data comparing clinical results with these stents to those obtaine d with conventional prostheses are sparse. Methods: We reviewed the re cords of all patients undergoing esophageal stent placement at our ins titution between October 1983 and July 1995 to define relative risks, clinical results, and need for reintervention prior to death, contrast ing conventional to a variety of expandable esophageal endoprostheses. Results: Over the period of review, 47 patients had conventional pros theses (OF) and 38 had expandable prostheses (EP) placed. Fifteen of 4 4 patients with CP and 14 of 38 with EP for malignancy also had esopha go-airway fistulas. Insertion complications, prestent and poststent dy sphagia scores, and complete fistula occlusion rates were comparable. Subacute complications were higher in the patients receiving EP (80%) than in those receiving CP (60%), possibly related to the prospective accumulation of data in patients receiving EP. Survival data were virt ually identical and approximated 3 months for either group. Conclusion s: Although both CP and EP improve dysphagia and occlude tracheoesopha geal fistulae, patients ill enough to require a prosthesis do poorly r egardless of prosthesis design. Moreover, although EP may be easier to insert than CP, stent- and patient-related problems persist and may r equire additional intervention.