ARE SELF-EXPANDING METAL STENTS AN EFFECT IVE TREATMENT FOR MALIGNANTESOPHAGEAL OBSTRUCTION - A PROSPECTIVE-STUDY OF 32 CASES

The treatment of esophageal carcinoma is frequently palliative. The ai ms of this prospective study were to evaluate the functional results o f covered self expanding esophageal metal stents in patients with mali gnant obstruction of the esophagus and to compare two models of stent. Patients and methods. - From April 1994 To August 1996, 32 patients w ere treated with 35 metal stents (Cook Z Stent(R) Wilson Cook : n = 21 ; Ultraflex(R) Boston Scientific: n = 14). Ten patients had a fistula. Previous treatment was effective in 30 patients. Initial score of dys phagia was 2.68 +/- 0.7. Initial score of Karnofsky was 60 +/- 10 %. T he metal stents could be placed in 100 % of cases. The 30-day mortalit y was 0 %. The morbidity of device placement of metal stents was 28 %. The treatment of fistulas was effective without complication in 100 % of cases. At month 3, we observed a significant decrease of dysphagia score (0.43 +/- 0.25) and a significant increase of Karnofsky Score ( 75 +/- IO %) (P < 0.001). The mean duration of hospitalization was 5.4 +/- 1.3 days. During mean follow-up of 18 +/- 3.5 months, 14 patients (44 %) died. Any difference concerning mortality and functional resul ts was observed between 2 kinds of metal stents. We only observed a si gnificant decrease of retrosternal pain retrosternal pain in patients treated with Ultraflex(R) prothesis. Conclusion. - Self-expanding esop hageal metal stents are a simple and effective palliative treatment of malignant obstruction of the esophagus. However, their high cost need other cost-efficacy studies to define their indications.