Factors That Affect Stent-Related Complications in Patients with Malignant Obstruction of the Esophagus or Gastric Cardia

Gut Liver. 2017 Jan 15;11(1):47-54. doi: 10.5009/gnl16172.

Abstract

Background/aims: Self-expandable metallic stent (SEMS) placement is effective for dysphagia that results from malignant obstruction of the esophagus or gastric cardia; however, stent-related complications may be life-threatening. Thus, the goal of this study was to identify risk factors associated with complications following esophageal stenting.

Methods: Of the 71 patients who underwent SEMS placement for dysphagia as a result of malignant stricture of the esophagus or gastric cardia, 53 patients with squamous cell carcinoma or adenocarcinoma, without previous SEMS placement, without a fistula, and without recurrent tumor after surgery were retrospectively identified. The occurrence of stent-related complications was used as an endpoint.

Results: Stent-related complications were identified in 26 patients (49.1%), and major complications occurred in 14 patients (26.4%). The use of an Ultraflex stent (odds ratio [OR], 6.81; 95% confidence interval [CI], 1.54 to 30.00; p=0.011) and prior chemotherapy (OR, 6.13; 95% CI, 1.46 to 25.70; p=0.013) were significantly associated with stent-related complications. Moreover, the use of an Ultraflex stent (OR, 19.60; 95% CI, 2.26 to 170.00; p=0.007) and prior radiation (OR, 25.70; 95% CI, 2.37 to 280.00; p=0.008) significantly increased the risk of major complications.

Conclusions: The use of an Ultraflex stent and prior radiation and/or chemotherapy may represent risk factors for complications following esophageal SEMS placement.

Keywords: Chemotherapy; Complication; Esophageal stent; Radiation; Risk factors.

MeSH terms

  • Adenocarcinoma / complications
  • Adenocarcinoma / surgery*
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use
  • Carcinoma, Squamous Cell / complications
  • Carcinoma, Squamous Cell / surgery*
  • Cardia / surgery*
  • Chemoradiotherapy
  • Constriction, Pathologic
  • Deglutition Disorders / etiology
  • Deglutition Disorders / surgery*
  • Esophageal Fistula / epidemiology
  • Esophageal Neoplasms / complications
  • Esophageal Neoplasms / surgery*
  • Esophageal Perforation / epidemiology
  • Esophageal Stenosis / etiology
  • Esophageal Stenosis / surgery*
  • Esophagoscopy
  • Female
  • Fever / epidemiology
  • Gastroscopy
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Palliative Care
  • Pneumonia, Aspiration / epidemiology
  • Postoperative Complications / epidemiology*
  • Postoperative Hemorrhage / epidemiology
  • Prosthesis Failure
  • Radiotherapy
  • Retrospective Studies
  • Self Expandable Metallic Stents*
  • Stomach Diseases / etiology
  • Stomach Diseases / surgery*

Substances

  • Antineoplastic Agents