Stents are commonly used for the palliation of dysphagia from esophageal or gastric cardia cancer.
A major drawback of stents is the occurrence of recurrent dysphagia.
Large-diameter stents were introduced for the prevention of migration but may be associated with more complications.
Dr Els Verschuur and colleagues from the Netherlands compared small- and large-diameter stents for improvement of dysphagia, complications, and recurrent dysphagia.
The team prospectively followed 338 patients with dysphagia from inoperable obstructing esophageal or gastric cardia cancer.
|Minor complications, such as pain, were associated with prior radiation|
Some patients also had recurrent dysphagia after prior radiation, with curative or palliative intent for esophageal cancer.
The team reported that 153 were treated with an Ultraflex stent, 89 with a Gianturco Z-stent, and 96 with a Flamingo Wallstent.
Of these patients, the team noted 265 had stents with small diameter, and 73 had large diameter stents during the period 1996 to 2004.
The team's main outcomes were dysphagia score, complications, and recurrent dysphagia.
The researchers observed that improvement in dysphagia was similar between patients with a small- or a large-diameter stent.
The occurrence of major complications, such as hemorrhage, perforation, fistula, and fever, was increased in patients with a large-diameter Gianturco Z-stent.
The team found that major complications were not increased in patients with a large-diameter Ultraflex stent or a Flamingo Wallstent.
Minor complications, particularly pain, were associated with prior radiation and/or chemotherapy in patients with a large- or a small-diameter Gianturco Z-stent.
The team noted that these minor complications were not associated with an Ultraflex stent or a Flamingo Wallstent.
Dysphagia from stent migration, tissue overgrowth, and food bolus obstruction reoccurred more frequently in patients with a small-diameter stent.
Dr Verschuur's team concluded, “Large-diameter stents reduce the risk of recurrent dysphagia from stent migration, tissue overgrowth, or food obstruction.”
“Increasing the diameter in some stent types may, however, increase the risk of stent-related complications to the esophagus.”