Self-expanding metal stents for palliative treatment of esophageal carcinoma: risk factors for fatal massive bleeding.

AIMS

To investigate the risk factors for the development of fatal massive bleeding after esophageal stenting in patients with malignant esophageal lesions.

METHODS

We performed a retrospective analysis of 216 patients with malignant esophageal stricture and esophageal fistulae who received esophageal stents recruited from January 2005 to December 2010 from the Shengjing Hospital of China Medical University. The patients were divided into 2 groups on the basis of the occurrence of fatal upper gastrointestinal bleeding. We evaluated the significance of sex, tumor site, type of stent, stent location, concomitant radiotherapy, esophageal fistulae, and tracheal stent as factors contributing to the development of esophageal bleeding in the 2 groups.

RESULTS

Fatal bleeding developed in 6.9% (15/216) of patients. These patients developed massive hematemesis and died shortly thereafter. The mean and median survival times for the remaining 201 patients were 182.3 and 75.5 days, respectively. The incidence of fatal bleeding was significantly higher among patients with esophageal fistulas and in patients with concomitant tracheal stents compared with those with neither condition. No significant relationship was identified between the incidence of fatal bleeding and age, sex, stent type, stent location, or radiotherapy. Multivariate regression analysis revealed that the presence of esophageal fistula and concomitant tracheal stent were closely related to fatal postoperative bleeding.

CONCLUSIONS

The presence of esophageal fistulae and concomitant tracheal stent are important factors contributing to heavy esophageal bleeding after esophageal stenting.