Palliation of malignant esophageal obstruction using an anti-migration self-expandable metal stent: Results of a prospective multicenter study - 14/05/21
, Maria Flavia Savarese a, Rosa Angela Filiberti c, Todd Huntley Baron d, Angelo Caruso e, Raffaele Manta f, Mario Marini g, Luca De Luca h, Antonella De Ceglie aBienvenue sur EM-consulte, la référence des professionnels de santé.
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| pages | 8 |
| Iconographies | 4 |
| Vidéos | 0 |
| Autres | 0 |
Highlights |
• | The main limitation of FCSEMS is migration, requiring endoscopic re-interventions. |
• | Attempts to reduce stent migration include anchoring the stent to the esophageal wall as the placement of trough-the-scope or over-the-scope clip clips. |
• | FCSEMS with different anti-migration systems have been used. |
• | Despite the anti-migration features, stent migration remains a major cause of recurrent dysphagia especially when stent is placed in the upper esophagus or across the esophago-gastric junction. |
Abstract |
Background |
Self-expanding metal stents (SEMS) placement is primarily indicated to palliate dysphagia for patients with expected short-term survival. We aimed to assess the migration rate and other stent-related adverse events (AEs) of a fully covered SEMS with an anti-migration system (FCSEMS-AMS) for palliation of malignant dysphagia.
Methods |
This is a prospective study including patients with inoperable esophageal cancer that received a FCSEMS-AMS (Taewoong, Niti-S Beta™), in five tertiary-care endoscopic centers from January 2014 to February 2016.
Results |
Fifty-three consecutive patients were enrolled. Tumor location was proximal, mid and distal esophagus±esophago-gastric junction (EGJ) in 6, 14, and 33 cases, respectively. Overall, non-severe AEs were reported in 18 patients (34.0%), 13 of them required an additional endoscopic procedure. Migration occurred in 7 patients (13.2%): 3 from the upper and 4 from the lower esophagus and EGJ. Stent retrieval was necessary in one patient due to intolerable pain. Food bolus impaction and tumor overgrowth occurred in 2 patients (3.8%) and 4 (7.5%) patients respectively. Four patients complained of gastroesophageal reflux as late AEs. Median follow-up was 19.3 months. Dysphagia significantly improved until 3 and 6 months from stent insertion (median score before FCSEMS-AMS: 3, vs median score: 1). Median dysphagia-free time was 10 months.
Conclusions |
Placement of the Taewoong, Niti-S Beta™ stent appeared to be a safe and effective treatment of malignant dysphagia. The anti-migration system reduced the overall migration rate, although it remained high in strictures located in the upper esophagus and when the stent was placed across the EGJ.
Le texte complet de cet article est disponible en PDF.Keywords : Palliation, Malignant esophageal obstruction, Metal stent
Plan
Vol 45 - N° 3
Article 101683- mai 2021 Retour au numéro
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