Esophageal Stents Relieve Cancer-Related Dysphagia

By Will Boggs, MD

NEW YORK MAR 05, 2008(Reuters Health) - Three types of esophageal stents provide palliation of dysphagia in patients with esophageal or gastric cardia cancer, according to a report in the February American Journal of Gastroenterology.

In a randomized trial, Dr. Peter D. Siersema from Erasmus MC University Medical Center Rotterdam, The Netherlands and associates compared the most commonly used Ultraflex stent with the newly designed Polyflex stent and Niti-S stent in 125 patients with dysphagia from inoperable carcinoma of the esophagus or gastric cardia.

Dysphagia (due to tissue growth, stent migration, or food obstruction) recurred less often with the newer devices (37% with Polyflex; 31% with Niti-S) than with the Ultraflex stent (52%), the authors report.

Stent migration was more common with the Polyflex stent (29%) than with the Ultraflex (17%) and Niti-S (12%) stents. Food obstruction requiring endoscopic cleansing was more common with the Ultraflex stent (24%) than with the Polyflex (5%) or Niti-S (2%) stents.

At 4 weeks after placement, the median dysphagia score had improved from 3 ("liquids only") to 1 ("ability to eat some solid food"). There was no significant difference among the stent types in the relief of dysphagia at 4 weeks, the researchers note, and median survival did not differ among patients in the 3 stent groups.

Complication rates were similar in the 3 groups, the investigators say.

"Ultraflex stents, Polyflex stents and Niti-S stents offer the same degree of palliation at the same level of safety in patients with inoperable carcinoma of the esophagus or gastric cardia," Dr. Siersema told Reuters Health. "Nonetheless, Polyflex stents seem the least preferable in this patient group, as placement of this device is technically demanding and associated with a high rate of stent migrations."

"We previously found that brachytherapy was favorable over (Ultraflex) stent placement with regard to long-term relief of dysphagia and the occurrence of fewer complications," Dr. Siersema explained. "The presently available new-generation stents probably offer no improvement for these two effects, meaning that brachytherapy is still a valuable option for palliation of dysphagia in esophageal cancer."v"An interesting study would be to compare the favorable stent in this study, the Niti-S stent, with a fractionated dose of brachytherapy, as it has been shown that a fractionated dose is more effective than single-dose brachytherapy," Dr. Siersema added.

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