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Gastroentérologie Clinique et Biologique
Vol 22, N° 1  - février 1998
p. 19
Doi : GCB-02-1998-22-1-0399-8320-101019-ART75
Are self-expanding metal stents an effective treatment for malignant esophageal obstruction ? A prospective study of 32 cases.

Alain ROLACHON, Emmanuel PAPILLON, Vincent LEROY, Nasser GUEDDAH, Jacques FOURNET

Are self-expanding metal stents an effective treatment for malignantesophageal obstruction ? A prospective study of 32 cases.

The treatment of esophageal carcinoma is frequently palliative. Theaims of this prospective study were to evaluate the functional results ofcovered self expanding esophageal metal stents in patients with malignantobstruction of the esophagus and to compare two models of stent.

Patients and methods. -- From April 1994 to August 1996, 32 patientswere treated with 35 metal stents (Cook Z Stent ® WilsonCook : n = 21 ; Ultraflex ® Boston Scientific :n = 14). Ten patients had a fistula. Previous treatment was effectivein 30 patients. Initial score of dysphagia was 2.68 ± 0.7.Initial score of Karnofsky was 60 ± 10 %. The metalstents could be placed in 100 % of cases. The 30-day mortality was0 %. 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 ± 10 %) (P < 0.001). The mean durationof hospitalization was 5.4 ± 1.3 days. During meanfollow-up of 18 ± 3.5 months, 14 patients (44 %)died. Any difference concerning mortality and functional results was observedbetween 2 kinds of metal stents. We only observed a significant decreaseof retrosternal pain in patients treated with Ultraflex ® prothesis.

Conclusion. -- Self-expanding esophageal metal stents are a simpleand effective palliative treatment of malignant obstruction of the esophagus.However, their high cost need other cost-efficacy studies to define theirindications.

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