Use of the 25 mm flanged esophageal Z stent for malignant dysphagia: A prospective multicenter trial

R. A. Kozarek, S. Raltz, N. Marcon, P. Kortan, G. Haber, C. Lightdale, P. Stevens, Glen Lehman, Douglas Rex, S. Benjamin, D. Fleischer, R. Bashir, S. Fry, I. Waxman, J. Benson, J. Polio

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Abstract

Background: An initial multicenter study using a 21 mm flanged esophageal Z stent demonstrated excellent palliation but an 11% immediate complication rate at placement and a 27% migration rate at 1 month. This North American multicenter trial prospectively studied a 25 mm flanged Z stent to define its palliative ability and whether the increased diameter affected placement or migration problems. Methods: Fifty patients who had esophageal Z stents at seven university or regional referral hospitals were prospectively studied. Indications for prosthesis placement, previous therapy, patient demographics, incidence of concomitant tracheoesophageal fistula, and degree of dysphagia were defined, as were procedural and subsequent stent-related problems, survival times, the ability to occlude a tracheoesophageal fistula, and subsequent degree of dysphagia. Results: Twenty-four patients had infiltrating malignancy (16 exophytic and 10 extrinsic), 9 of whom had concomitant tracheoesophageal fistulas. Ten patients (20%) had misplaced stents requiring retrieval and replacement, 12 patients (24%) had subsequent stent-related problems including exsanguination (2), aspiration (3), tumor overgrowth (3), and postplacement migration (4) (8%). There was statistically significant improvement in prestent versus poststent dysphagia and two thirds of patients had complete occlusion of their tracheoesophageal fistula. Conclusions: Redesign of the esophageal Z stent has decreased the migration rate without increasing placement or subsequent erosion problems. Its efficacy appears comparable to the currently marketed Z stent for the palliation of malignant dysphagia and occlusion of tracheoesophageal fistula.

Original languageEnglish (US)
Pages (from-to)156-160
Number of pages5
JournalGastrointestinal Endoscopy
Volume46
Issue number2
DOIs
StatePublished - 1997

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Deglutition Disorders
Multicenter Studies
Stents
Tracheoesophageal Fistula
Exsanguination
Prostheses and Implants
Neoplasms
Referral and Consultation
Demography
Survival
Incidence

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Kozarek, R. A., Raltz, S., Marcon, N., Kortan, P., Haber, G., Lightdale, C., ... Polio, J. (1997). Use of the 25 mm flanged esophageal Z stent for malignant dysphagia: A prospective multicenter trial. Gastrointestinal Endoscopy, 46(2), 156-160. https://doi.org/10.1016/S0016-5107(97)70065-8

Use of the 25 mm flanged esophageal Z stent for malignant dysphagia : A prospective multicenter trial. / Kozarek, R. A.; Raltz, S.; Marcon, N.; Kortan, P.; Haber, G.; Lightdale, C.; Stevens, P.; Lehman, Glen; Rex, Douglas; Benjamin, S.; Fleischer, D.; Bashir, R.; Fry, S.; Waxman, I.; Benson, J.; Polio, J.

In: Gastrointestinal Endoscopy, Vol. 46, No. 2, 1997, p. 156-160.

Research output: Contribution to journalArticle

Kozarek, RA, Raltz, S, Marcon, N, Kortan, P, Haber, G, Lightdale, C, Stevens, P, Lehman, G, Rex, D, Benjamin, S, Fleischer, D, Bashir, R, Fry, S, Waxman, I, Benson, J & Polio, J 1997, 'Use of the 25 mm flanged esophageal Z stent for malignant dysphagia: A prospective multicenter trial', Gastrointestinal Endoscopy, vol. 46, no. 2, pp. 156-160. https://doi.org/10.1016/S0016-5107(97)70065-8
Kozarek, R. A. ; Raltz, S. ; Marcon, N. ; Kortan, P. ; Haber, G. ; Lightdale, C. ; Stevens, P. ; Lehman, Glen ; Rex, Douglas ; Benjamin, S. ; Fleischer, D. ; Bashir, R. ; Fry, S. ; Waxman, I. ; Benson, J. ; Polio, J. / Use of the 25 mm flanged esophageal Z stent for malignant dysphagia : A prospective multicenter trial. In: Gastrointestinal Endoscopy. 1997 ; Vol. 46, No. 2. pp. 156-160.
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T2 - A prospective multicenter trial

AU - Kozarek, R. A.

AU - Raltz, S.

AU - Marcon, N.

AU - Kortan, P.

AU - Haber, G.

AU - Lightdale, C.

AU - Stevens, P.

AU - Lehman, Glen

AU - Rex, Douglas

AU - Benjamin, S.

AU - Fleischer, D.

AU - Bashir, R.

AU - Fry, S.

AU - Waxman, I.

AU - Benson, J.

AU - Polio, J.

PY - 1997

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N2 - Background: An initial multicenter study using a 21 mm flanged esophageal Z stent demonstrated excellent palliation but an 11% immediate complication rate at placement and a 27% migration rate at 1 month. This North American multicenter trial prospectively studied a 25 mm flanged Z stent to define its palliative ability and whether the increased diameter affected placement or migration problems. Methods: Fifty patients who had esophageal Z stents at seven university or regional referral hospitals were prospectively studied. Indications for prosthesis placement, previous therapy, patient demographics, incidence of concomitant tracheoesophageal fistula, and degree of dysphagia were defined, as were procedural and subsequent stent-related problems, survival times, the ability to occlude a tracheoesophageal fistula, and subsequent degree of dysphagia. Results: Twenty-four patients had infiltrating malignancy (16 exophytic and 10 extrinsic), 9 of whom had concomitant tracheoesophageal fistulas. Ten patients (20%) had misplaced stents requiring retrieval and replacement, 12 patients (24%) had subsequent stent-related problems including exsanguination (2), aspiration (3), tumor overgrowth (3), and postplacement migration (4) (8%). There was statistically significant improvement in prestent versus poststent dysphagia and two thirds of patients had complete occlusion of their tracheoesophageal fistula. Conclusions: Redesign of the esophageal Z stent has decreased the migration rate without increasing placement or subsequent erosion problems. Its efficacy appears comparable to the currently marketed Z stent for the palliation of malignant dysphagia and occlusion of tracheoesophageal fistula.

AB - Background: An initial multicenter study using a 21 mm flanged esophageal Z stent demonstrated excellent palliation but an 11% immediate complication rate at placement and a 27% migration rate at 1 month. This North American multicenter trial prospectively studied a 25 mm flanged Z stent to define its palliative ability and whether the increased diameter affected placement or migration problems. Methods: Fifty patients who had esophageal Z stents at seven university or regional referral hospitals were prospectively studied. Indications for prosthesis placement, previous therapy, patient demographics, incidence of concomitant tracheoesophageal fistula, and degree of dysphagia were defined, as were procedural and subsequent stent-related problems, survival times, the ability to occlude a tracheoesophageal fistula, and subsequent degree of dysphagia. Results: Twenty-four patients had infiltrating malignancy (16 exophytic and 10 extrinsic), 9 of whom had concomitant tracheoesophageal fistulas. Ten patients (20%) had misplaced stents requiring retrieval and replacement, 12 patients (24%) had subsequent stent-related problems including exsanguination (2), aspiration (3), tumor overgrowth (3), and postplacement migration (4) (8%). There was statistically significant improvement in prestent versus poststent dysphagia and two thirds of patients had complete occlusion of their tracheoesophageal fistula. Conclusions: Redesign of the esophageal Z stent has decreased the migration rate without increasing placement or subsequent erosion problems. Its efficacy appears comparable to the currently marketed Z stent for the palliation of malignant dysphagia and occlusion of tracheoesophageal fistula.

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