Prospective multicenter trial of esophageal Z-stent placement for malignant dysphagia and tracheoesophageal fistula

R. A. Kozarek, S. Raltz, W. R. Brugge, R. H. Schapiro, I. Waxman, H. W. Boyce, J. Baillie, S. Branch, P. Stevens, C. J. Lightdale, Glen Lehman, S. Benjamin, D. E. Fleischer, A. Axelrad, P. Kortan, N. Marcon

Research output: Contribution to journalArticle

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Abstract

Background: Conventional esophageal prosthesis placement has been associated with a 6% to 8% perforation rate and numerous postplacement complications. Expandable esophageal stents have been developed to preclude the above but there are few studies that have prospectively defined clinical results and subsequent stent-related complications. Methods: All patients who underwent esophageal Z-stent placement at nine university or referral hospitals were prospectively assessed. Data collected included patient demographics, acute and subacute placement problems, the ability to occlude airway fistulas, prestent and poststent dysphagia scores, and patient survival. Results: Fifty-four of 56 patients (96%) with refractory dysphagia or malignant esophagoairway fistulae had 73 Z-stents successfully inserted. Initial distal deployment occurred in 13% of the patients and an additional 17% required balloon dilation to achieve maximal diameter. Acute placement complications occurred in 11% of patients and included severe pain (3), bleeding from necrotic tumor (2), and hiatal hernia intussusception (1). No perforations occurred. Eight of 11 patients (73%) had complete tracheoesophageal fistula occlusion and mean dysphagia score (±SD) improved from 2.6 (0.7) to 1.1 (1.2) (p <0.01). Fifteen stents (27%) had delayed migration at a mean of 1 month and 3 required surgery for retrieval. Three patients had ultimate stent erosion resulting in bleeding in 2 (exsanguination 1) or fistula (treated with a conventional stent). Conclusions: The authors conclude that esophageal Z-stents can be placed safely and successfully in the majority of patients. The tendency of distal deployment during placement and subsequent migration problems at a time distant from placement in a patient subset deserve attention and are currently being addressed.

Original languageEnglish (US)
Pages (from-to)562-567
Number of pages6
JournalGastrointestinal Endoscopy
Volume44
Issue number5
DOIs
StatePublished - 1996
Externally publishedYes

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Tracheoesophageal Fistula
Deglutition Disorders
Multicenter Studies
Stents
Fistula
Hemorrhage
Exsanguination
Hiatal Hernia
Aptitude
Intussusception
Prostheses and Implants
Dilatation
Referral and Consultation
Demography

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Kozarek, R. A., Raltz, S., Brugge, W. R., Schapiro, R. H., Waxman, I., Boyce, H. W., ... Marcon, N. (1996). Prospective multicenter trial of esophageal Z-stent placement for malignant dysphagia and tracheoesophageal fistula. Gastrointestinal Endoscopy, 44(5), 562-567. https://doi.org/10.1016/S0016-5107(96)70009-3

Prospective multicenter trial of esophageal Z-stent placement for malignant dysphagia and tracheoesophageal fistula. / Kozarek, R. A.; Raltz, S.; Brugge, W. R.; Schapiro, R. H.; Waxman, I.; Boyce, H. W.; Baillie, J.; Branch, S.; Stevens, P.; Lightdale, C. J.; Lehman, Glen; Benjamin, S.; Fleischer, D. E.; Axelrad, A.; Kortan, P.; Marcon, N.

In: Gastrointestinal Endoscopy, Vol. 44, No. 5, 1996, p. 562-567.

Research output: Contribution to journalArticle

Kozarek, RA, Raltz, S, Brugge, WR, Schapiro, RH, Waxman, I, Boyce, HW, Baillie, J, Branch, S, Stevens, P, Lightdale, CJ, Lehman, G, Benjamin, S, Fleischer, DE, Axelrad, A, Kortan, P & Marcon, N 1996, 'Prospective multicenter trial of esophageal Z-stent placement for malignant dysphagia and tracheoesophageal fistula', Gastrointestinal Endoscopy, vol. 44, no. 5, pp. 562-567. https://doi.org/10.1016/S0016-5107(96)70009-3
Kozarek, R. A. ; Raltz, S. ; Brugge, W. R. ; Schapiro, R. H. ; Waxman, I. ; Boyce, H. W. ; Baillie, J. ; Branch, S. ; Stevens, P. ; Lightdale, C. J. ; Lehman, Glen ; Benjamin, S. ; Fleischer, D. E. ; Axelrad, A. ; Kortan, P. ; Marcon, N. / Prospective multicenter trial of esophageal Z-stent placement for malignant dysphagia and tracheoesophageal fistula. In: Gastrointestinal Endoscopy. 1996 ; Vol. 44, No. 5. pp. 562-567.
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T1 - Prospective multicenter trial of esophageal Z-stent placement for malignant dysphagia and tracheoesophageal fistula

AU - Kozarek, R. A.

AU - Raltz, S.

AU - Brugge, W. R.

AU - Schapiro, R. H.

AU - Waxman, I.

AU - Boyce, H. W.

AU - Baillie, J.

AU - Branch, S.

AU - Stevens, P.

AU - Lightdale, C. J.

AU - Lehman, Glen

AU - Benjamin, S.

AU - Fleischer, D. E.

AU - Axelrad, A.

AU - Kortan, P.

AU - Marcon, N.

PY - 1996

Y1 - 1996

N2 - Background: Conventional esophageal prosthesis placement has been associated with a 6% to 8% perforation rate and numerous postplacement complications. Expandable esophageal stents have been developed to preclude the above but there are few studies that have prospectively defined clinical results and subsequent stent-related complications. Methods: All patients who underwent esophageal Z-stent placement at nine university or referral hospitals were prospectively assessed. Data collected included patient demographics, acute and subacute placement problems, the ability to occlude airway fistulas, prestent and poststent dysphagia scores, and patient survival. Results: Fifty-four of 56 patients (96%) with refractory dysphagia or malignant esophagoairway fistulae had 73 Z-stents successfully inserted. Initial distal deployment occurred in 13% of the patients and an additional 17% required balloon dilation to achieve maximal diameter. Acute placement complications occurred in 11% of patients and included severe pain (3), bleeding from necrotic tumor (2), and hiatal hernia intussusception (1). No perforations occurred. Eight of 11 patients (73%) had complete tracheoesophageal fistula occlusion and mean dysphagia score (±SD) improved from 2.6 (0.7) to 1.1 (1.2) (p <0.01). Fifteen stents (27%) had delayed migration at a mean of 1 month and 3 required surgery for retrieval. Three patients had ultimate stent erosion resulting in bleeding in 2 (exsanguination 1) or fistula (treated with a conventional stent). Conclusions: The authors conclude that esophageal Z-stents can be placed safely and successfully in the majority of patients. The tendency of distal deployment during placement and subsequent migration problems at a time distant from placement in a patient subset deserve attention and are currently being addressed.

AB - Background: Conventional esophageal prosthesis placement has been associated with a 6% to 8% perforation rate and numerous postplacement complications. Expandable esophageal stents have been developed to preclude the above but there are few studies that have prospectively defined clinical results and subsequent stent-related complications. Methods: All patients who underwent esophageal Z-stent placement at nine university or referral hospitals were prospectively assessed. Data collected included patient demographics, acute and subacute placement problems, the ability to occlude airway fistulas, prestent and poststent dysphagia scores, and patient survival. Results: Fifty-four of 56 patients (96%) with refractory dysphagia or malignant esophagoairway fistulae had 73 Z-stents successfully inserted. Initial distal deployment occurred in 13% of the patients and an additional 17% required balloon dilation to achieve maximal diameter. Acute placement complications occurred in 11% of patients and included severe pain (3), bleeding from necrotic tumor (2), and hiatal hernia intussusception (1). No perforations occurred. Eight of 11 patients (73%) had complete tracheoesophageal fistula occlusion and mean dysphagia score (±SD) improved from 2.6 (0.7) to 1.1 (1.2) (p <0.01). Fifteen stents (27%) had delayed migration at a mean of 1 month and 3 required surgery for retrieval. Three patients had ultimate stent erosion resulting in bleeding in 2 (exsanguination 1) or fistula (treated with a conventional stent). Conclusions: The authors conclude that esophageal Z-stents can be placed safely and successfully in the majority of patients. The tendency of distal deployment during placement and subsequent migration problems at a time distant from placement in a patient subset deserve attention and are currently being addressed.

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