A new design metal stent (Flamingo stent) for palliation of malignant dysphagia: a prospective study

Background: Metal stents are not superior to conventional endoprostheses wi th respect to the incidence of recurrent dysphagia because of tumor ingrowt h with uncovered stents and migration with their covered counterparts. To o vercome these limitations, a partially covered (inside-out covering) metal stent with a conical shape and a varying braiding angle of the mesh along i ts length, the Flamingo stent, has been developed. Methods: From March 1997 to October 1997, 40 consecutive patients with dysp hagia due to malignant tumors had either a small diameter (proximal/distal diameter 24/16 mm; n = 21) or a large diameter Flamingo stent (proximal/dis tal diameter 30/20 mm; n = 19) placed. Results: There was statistically significant improvement in dysphagia, but improvement was not greater with large diameter stents compared to small di ameter stents (p = 0.21), Major complications (bleeding [4], perforation [1 ], fever [1] and fistula [1]) occurred in 7 (18%) patients. Large diameter stents tended to be associated with more major complications than small dia meter stents (5 vs. 2; p = 0.07). Pain following stent placement was observ ed in 9 (22%) patients and occurred more frequently in those who had prior radiation and/or chemotherapy (p = 0.02), Recurrent dysphagia (mainly due t o tumor overgrowth) occurred in 10 (25%) patients, Conclusions: Flamingo stents are effective for palliation of malignant dysp hagia, but the large diameter stent seems to be associated with more compli cations involving the esophagus than the small diameter stent, Because recu rrent dysphagia is mainly due to tumor progression, further technical devel opments in stent design are needed.