Original ArticleClinical EndoscopyEffect of stent size on complications and recurrent dysphagia in patients with esophageal or gastric cardia cancer
Section snippets
Patients
At the Erasmus MC University Medical Center Rotterdam, from January 1996 to December 2004, 556 patients were treated with a metal stent in the esophagus or the gastric cardia. Data from these patients were collected in a prospective database. Informed consent of patients to analyze this information is not needed in The Netherlands. Patients were included if they had an inoperable malignant obstruction of the esophagus or the gastric cardia, or recurrent dysphagia after prior radiation with
Clinical characteristics
Clinical characteristics of the 338 patients treated with a small-diameter (n = 265) or a large-diameter (n = 73) stent and fulfilling the inclusion criteria are shown in Table 1. In approximately 20% of patients, the tumor was located in the gastric cardia, whereas, in the remainder, it was located in the esophagus. Large-diameter stents were more frequently placed in patients with a tumor located in the gastric cardia (P < .0001). If the Flamingo Wallstent was used, then a large-diameter
Discussion
This nonrandomized comparison between small- and large-diameter stents demonstrated that endoscopic placement of large-diameter stents was associated with a lower frequency of recurrent dysphagia from stent migration, tissue overgrowth, and food-bolus obstruction. Nonetheless, for some stent types, particularly the Gianturco Z-stent, increasing the stent size will likely result in more stent-related complications to the esophagus.
Migration is suggested to occur more frequently with stents
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See CME section; p. 672.