How to design the optimal self-expandable oesophageal metallic stents: 22 years of experience in 645 patients with malignant strictures

Han Kyu Na, Ho Young Song, Jin Hyoung Kim, Jung Hoon Park, Min Kyoung Kang, Jongjin Lee, Se Jin Oh

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Objectives: To evaluate the clinical efficacy and safety of self-expandable metallic stent (SEMS) placement for malignant oesophageal strictures and their relationship with stent designs. Methods: Seven generations of SEMS were used to treat 645 consecutive patients with oesophageal strictures. Logistic regression models were constructed to identify predictive factors associated with complications. Results: Stent placement was technically successful in 641 of 645 patients (99.4%). The clinical success rate was 95.5%. There were 260 (40.3%) complications after stent placement. Due to complications, 68 stents were removed; 66 of 68 stents (97.1%) were removed successfully. Stainless steel (SS) stents (odds ratio [OR] 4.18; 95% confidence interval [CI] 2.10, 8.32) and radiation therapy (RT) before stent placement (OR 4.23; CI 2.02, 8.83) were significantly associated with severe pain. Flared ends (OR 9.63; CI 3.38, 27.43), stricture length <6 cm (OR 2.01; CI 1.13, 3.60), and a stent diameter <18 mm (OR 3.00; CI 1.32, 6.84) were predictive factors of stent migration. Polyurethane membranes were associated with more frequent tumour ingrowth than polytetrafluoroethylene (PTFE) membranes (P = 0.002). Conclusions: Despite the relatively high complication rate, retrievable self-expandable PTFE-covered nitinol stents equipped with a head and a tail appeared to be an effective treatment for malignant oesophageal strictures. Key Points: • Self-expandable metallic stents are now widely used for palliating unresectable oesophageal strictures • Stents equipped with a head and a tail showed decreased stent migration rate • Stainless steel stents and radiation therapy before stenting can cause severe pain • Polyurethane membranes were associated with more frequent tumour ingrowth than polytetrafluoroethylene membranes • Considering the high complication rate, stent retrievability is important for safety reasons

Original languageEnglish (US)
Pages (from-to)786-796
Number of pages11
JournalEuropean Radiology
Volume23
Issue number3
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

Keywords

  • Oesophageal carcinoma
  • Oesophageal stent
  • Optimal stent design
  • Self-expandable metallic stents
  • Stent-related complications

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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