SELF-EXPANDING METAL STENTS IN MALIGNANT ESOPHAGEAL OBSTRUCTION - A COMPARISON BETWEEN 2 STENT TYPES

Objectives: Self-expanding metal stents are a promising alternative in the palliation of malignant esophageal obstruction, but the relative value of different stent types is not well established. Methods: Durin g a 3-year enrollment period in four different centers, 82 consecutive patients with malignant dysphagia without tumor recurrence after surg ery or esophagorespiratory fistulas received either an uncovered Walls tent (44 patients) or a knitted nitinol stent (38 patients). Results: Age (median: 79 yr), sex (F:M = 33:67), dysphagia score (median: 3), K arnofsky score (median: 53), body mass index (median: 19), type of pre treatment, tumor stage, stricture length (median: 5.4 cm), and strictu re location were comparable in both stent groups. After stent placemen t, median dysphagia score improved markedly in both groups by two poin ts. Procedure-related mortality (16 vs 0%; p < 0.01), early complicati on rate (32 vs 8%; p < 0.01), and severe persistent pain after stent p lacement (23 vs 0%; p < 0.002) were higher in the Wallstent compared w ith the knitted nitinol stent group. In contrast, stent dysfunction (7 vs 32%; p < 0.005), reintervention rate (9 vs 34%; p < 0.005), and co sts were lower in the Wallstent compared with the nitinol stent group. Conclusions: In malignant esophageal obstruction, both stents markedl y improved dysphagia. Uncovered Wallstents seem to cause more early se vere complications than knitted nitinol stents. In contrast, stent dys function, reintervention rate, and costs appear to be higher in the ni tinol stent group.