Increased risk of complications associated with proximal esophageal stent placement

R. M. Bashir, D. E. Fleischer, D. Pinto, S. W. Fry, G. M. Eisen, F. H. Al-Kawas, S. B. Benjamin

Research output: Contribution to journalArticle

Abstract

Data comparing conventional (CP) and expandable (EP) esophageal stent-related complications are limited. Our aim was to determine whether complications were associated with the specific location of esophageal stent placement. Methods: All patients who underwent esophageal stent placement for malignant esophageal obstruction between 11/87 and 11/95 were reviewed. Data collection included patient demographics, procedural indication, specific location of stenosis, stent type, and stent-related complications. Stents were categorized as proximal (within 8 cm of the UES), distal (within 8 cm of the GE junction), or mid (all remaining) based on the location of stenosis and stent deployment by the endoscopist. All complications were prospectively recorded and evaluated at monthly QA meetings. Results: 96 patients (68 M, 28F, mean= 67.2y) underwent 118 esophageal stent placements (95 CPP (Wilson-Cook 74,Bard 14,Key-Med 7); 23 EMP (Ztm 14,Wallstenttm6,Ultraflextm 2,Esophacoiltm 1)) for malignant esophageal obstruction (99 Esoph CA, 4 Lung CA). Of 118 stents, 26 (22%) were placed proximally (PE), 55 (47%) in the mid-esophagus (ME), and 37 (31%) distally (DE). Overall complications are summarized in table. Proximal Esoph Mid-Esoph : Distal Esoph (n=26) (n=55) (n=37) All Complications 19 (73%)123 25 (45%) 15 (41%) CP (n=94) 12/18 (67%) 16/44 (36%) 13/34 (38%) EP (n=23) 7/8 (88%) 9/11(82%) 2/3 (67%) 1 Prox-Esoph vs. Mid Esoph., p<.05; 2 Prox-Esoph vs. Distal-Esoph, p<.05; 3 Prox-Esoph vs. Mid+Distal, p=.01 No statistical difference was noted in tumor ingrowth, stent migration, or perforation regardless of stent type or stent location. All of the three stent-related patient deaths (aspiration (1), pneumothorax (1), respiratory arrest (1)) occurred in patients with proximally placed stents (CP 2, EP 1) (PE vs ME or DE,p<.05). Conclusions: Complications Occurred more frequently in proximally placed stents, compared with stents placed in the mid or distal esophagus, regardless of stent type (p<.05). Deaths occurred more often in patients with proximally placed stents and were due to respiratory complications.

Original languageEnglish (US)
Number of pages1
JournalGastrointestinal endoscopy
Volume43
Issue number4
DOIs
StatePublished - Jan 1 1996
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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