Coated self-expanding metal stents versus latex prostheses for esophagogastric cancer with special reference to prior radiation and chemotherapy: a controlled, prospective study

被引:161
作者
Siersema, PD
Hop, WCJ
Dees, J
Tilanus, HW
van Blankenstein, M
机构
[1] Univ Hosp Dijkzigt, Dept Gastroenterol & Hepatol Internal Med 2, NL-3015 GD Rotterdam, Netherlands
[2] Univ Hosp Dijkzigt, Dept Epidemiol & Biostat, NL-3015 GD Rotterdam, Netherlands
[3] Univ Hosp Dijkzigt, Dept Surg, NL-3015 GD Rotterdam, Netherlands
关键词
D O I
10.1016/S0016-5107(98)70342-6
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Self-expanding metal stents seem to be safer than conventional prostheses for palliation of malignant esophagogastric obstruction. However, recurrent dysphagia caused by tumor ingrowth in uncoated types remains a problem. In addition, prior radiation and/or chemotherapy may entail an increased risk of complications. Methods: Seventy-five patients with an esophagogastric carcinoma were randomly assigned to placement of a latex prosthesis under general anesthesia or a coated, self-expanding metal stent under sedation. At entry, patients were stratified for location of the tumor in the esophagus or cardia and for prior radiation and/or chemotherapy. Results: Technical success and improvement in dysphagia score were similar in both groups. Major complications were more frequent with latex prostheses (47%) than with metal stents (16%) (odds ratio 4.07: 95% CI [1.35, 12.50], p = 0.014). Recurrent dysphagia was not different between rater prostheses (26%) and metal stents (24%). Hospital stay was longer, on average, after placement of latex prostheses than metal stents (6.3 +/- 5.2 versus 4.3 +/- 2.3 days; p = 0.043). Only prior radiation and/or chemotherapy increased the risk of specific device-related complications with respect to the esophagus (12 of 28 [43%] versus 8 of 47 [17%]; odds ratio 3.66: 95% CI [1.24, 10.82], p = 0.029). Conclusions: Coated, self-expanding metal stents are associated with fewer complications and shorter hospital stay as compared with rater prostheses, and prior radiation and/or chemotherapy increases the risk of device-related complications with respect to the esophagus.
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页码:113 / 120
页数:8
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