Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
Department of Gastroenterology, Surgery Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil.
Gastrointest Endosc. 2017 Aug;86(2):299-306. doi: 10.1016/j.gie.2016.12.017. Epub 2016 Dec 23.
Self-expandable metallic stents are considered the best palliative treatment of dysphagia for patients with advanced esophageal cancer. Adverse events (AEs) are a major concern, especially in patients with better prognosis and longer survival. The present study aimed to evaluate the AEs of patients who survived longer than 6 months with esophageal stents in place.
This is a retrospective analysis of a prospectively collected database including all patients submitted to esophageal stent placement for the palliation of malignant diseases during the period from February 2009 to February 2014 at a tertiary care academic center who had stents longer than 6 months.
Sixty-three patients were included. Mean follow-up was 10.7 months. Clinical success was achieved in all patients, and the median stent patency was 7.1 months. AEs occurred in 40 patients (63.5%), totaling 62 AEs (mean, 1.5 AEs per patient). Endoscopic management of AEs was successful in 84.5% of cases, with a mean of 1.6 reinterventions per patient. The univariate analysis revealed that performance status, age, and post-stent radiotherapy presented a trend to higher risk of AEs. The multivariate analysis revealed that only performance status was associated with AEs (P = .025; hazard ratio, 4.1).
AEs are common in patients with long-term esophageal stenting for malignancy. However, AEs were not related to higher mortality rate, and most AEs could be successfully managed by endoscopy. Only performance status was a risk factor for AEs. Our data suggest that metallic stenting is a valid option for the treatment of malignant esophageal conditions, even when survival longer than 6 months is expected.
自膨式金属支架被认为是治疗晚期食管癌所致吞咽困难的最佳姑息治疗方法。不良事件（AEs）是一个主要关注点，尤其是在预后较好且生存时间较长的患者中。本研究旨在评估生存时间超过 6 个月的食管支架置入患者的 AEs。
这是一项回顾性分析，纳入了 2009 年 2 月至 2014 年 2 月期间在一家三级学术中心因恶性疾病接受食管支架置入以缓解症状的所有患者的前瞻性数据库资料，这些患者的支架留置时间超过 6 个月。
共纳入 63 例患者。平均随访时间为 10.7 个月。所有患者均获得临床成功，中位支架通畅时间为 7.1 个月。40 例（63.5%）患者发生 AEs，共计 62 例（平均每位患者 1.5 例）。84.5%的 AEs 通过内镜处理成功，平均每位患者需 1.6 次再次介入。单因素分析显示，体能状态、年龄和支架置入后放疗与 AEs 风险增加呈趋势相关。多因素分析显示，仅体能状态与 AEs 相关（P =.025；风险比，4.1）。
恶性肿瘤长期食管支架置入患者 AEs 较为常见。然而，AEs 与较高的死亡率无关，大多数 AEs 可通过内镜成功处理。仅体能状态是 AEs 的危险因素。我们的数据表明，金属支架是治疗恶性食管疾病的有效选择，即使预计生存时间超过 6 个月也是如此。
