Prospective evaluation of expandable esophageal stents (EES) on dysphagia, quality of life (QLI), and karnofsky scores (KP)

EES are now the mainstay of endoscopic therapy for pts with unresectable malignant dysphagia. While technically successful, there are few data that assess impact of therapy on pt outcome. AIMS: Determine impact of EES on dysphagia score, QLI, KP, and pt satisfaction. METHODS: Pts with dysphagia from malignancy underwent EES placement. Tumor margins were marked with metal endoclips (Olympus). Following deployment, all stents (with one exception) were fixed at the proximal barb to the normal mucosa using endoclips to prevent stent migration. Data were collected at baseline and monthly intervals by phone interviews until death. ANOVA's assessed effect of tx over time, and regression analysis was used to identify the best predictor of improvement in dysphagia. RESULTS: 18 pts underwent stent therapy (10 Wallstent, 8 Ultraflex). M=16, F=2. Mean age 64 yrs. (37-84). Primary malignancy was esophageal (6), gastric (5), lung (7). TE fistula (6/18). Mean survival 3 mos. 30 day mortality 2/18. Complications: stent migration (1), reflux/chest pain (2), ulcer at proximal stent (1). All pts died of disease progression. The one pt with stent migration did not have a clip fixed after deployment because of respiratory compromise and early termination of the procedure. TIME (MOS) DYSPHAGIA (0-4)* KP (0-100)* QLI (0-10)* PT SATISFACTION (0-5)* Baseline 3.8±.4 36±8 2.8±.8 .8±.9 One Month 2.0±.2 50±5 4.8±.5 3.1±.3 Final Month Before Death 2.2±.2 23±4 2.9±.3 2.0±.2 * p<.05 significant change over time In comparison to intrinsic versus extrinsic compression, and type of stent, presence of a TE fistula (regression analysis, r²=.42, p<.05) was the best predictor of improvement in dysphagia grade. CONCLUSIONS: Stent migration may be prevented by clipping the stent to the mucosa after deployment. Dysphagia grade, Karnofsky score, QLI, and pt satisfaction improve at one month follow-up. Dysphagia remains improved until death, but KP, QLI, and pt satisfaction gradually decline with disease progression. Presence of a TE fistula is the best predictor for improvement in dysphagia.