[Self-expanding metal endoprosthesis in palliation of stenosing tumors of the upper gastrointestinal tract. Comparison of experience with three stent types in 82 implantations].

INTRODUCTION AND AIM OF STUDY

As there are no reports of studies comparing different self-expanding metal stent types the results obtained with three stent types in 73 patients (58 men, 15 women; mean age 65 [43-90] years who had a total of 82 implantation were analysed.

PATIENTS AND METHODS

31 Wallstents were implanted in 23 patients, 31 Ultraflex stents (all without covering) in 30 patients, and 20 Gianturco-Z stents (with covering) in 20 patients. The three groups of patients did not differ significantly with respect to degree of dysphagia, frequency of previous treatment, length of stenosis by tumour, tumour localization and histological tumour type. Six patients, treated with the Gianturco-Z stent, had an tracheo-oesophageal fistula.

RESULTS

All 82 implantations were technically successful. Complete occlusion was achieved in all patients with fistulas, as proven radiologically. Serious early complications, namely stent migration, occurred in two patients (2.4%). The degree of dysphagia improved equally in all three groups (Wallstent, from 2.0 to 0.7; Ultraflex from 2.2 to 0.9, Gianturco-Z from 2.1 to 0.5 (not significant). The median follow-up time differed: 89 days for the Wallstent group, 129 for the Ultraflex group and 77 days for the Gianturco-Z group. Tumour ingrowth was the main problem with the non-covered stents. Accordingly, there were 43% reinterventions with the Wallstent, 37% with the Ultraflex and 20% with the Gianturco-Z stents.

CONCLUSIONS

Self-expanding metal stents improve palliative treatment of stenosing tumours of the oesophagus and cardia, particularly in view of the low complication rate (< 3%) in the early postimplantation phase. But technical improvements are needed to reduce the number of reinterventions for restenosis in the follow-up period.