Post written by Bruno Costa Martins, MD, from the Endoscopy Division at the Cancer Institute of the University of São Paulo.
The focus of this study was to evaluate the long-term behavior of esophageal metallic stents in patients with malignant disease and palliative intent.
Esophageal metallic stents are considered the mainstay palliative treatment for patients with inoperable esophageal cancer. It provides rapid and efficient relief of dysphagia. Esophageal stents in the palliative setting are intended to linger permanently. However, little is known about the long-term adverse events (AE) in patients with better prognosis and long-term survival. This is relevant for decision making about stenting timing: should we postpone stent insertion as much as possible, ie, as the last resource for dysphagia relief, or can we offer esophageal stents in an earlier phase of treatment?
Long-term results of esophageal stents were studied on 63 patients who remained with the stents in place for more than 6 months. Adverse events occurred in 40 patients (63.5%), with a mean of 1.5 AE per patient. However, most AE were minor (76%) and could be managed successfully by endoscopy in 84.5% of cases. The only predictive factor for the occurrence of AE at multivariate analysis was performance status. Interestingly, although AE were common in these patients, it was not related to a higher mortality rate.
Figure 1. Study flowchart. *Patients not submitted to endoscopic intervention were treated with nasoenteral tube or gastrostomy. †Food impaction (n = 4) and GERD (n = 1). NA, Not applicable. Adverse event not amenable to endoscopic treatment.
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.
Find the article abstract here.
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