A randomised prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma

Abstract

Background: Covered metallic oesophageal stents offer effective palliation of malignant oesophageal strictures. However, first generation devices were associated with a high rate of migration, particularly when used in the lower oesophagus. Aim: To compare the rate of complications and palliative effect of two newer covered metallic oesophageal stents. Patients and methods: We performed a prospective randomised study using two of these newer stent designs in the treatment of malignant lower third oesophageal tumours. Fifty three patients with dysphagia due to inoperable oesophageal carcinoma involving the lower third of the oesophagus were randomly selected to receive either a Flamingo covered Wallstent (Boston Scientific Inc., Watertown, Massachusetts, USA) or an Ultraflex covered stent (Boston Scientific Inc.). Dysphagia was scored on a five point scale, recorded before stent insertion, the day after, and at least one month later at follow up. Technical success, early and late complications (perforation, migration, severe gastro-oesophageal reflux, haematemesis, and reobstruction due to tumour overgrowth) were also recorded. Results: In both stent groups, a significant improvement in dysphagia score was seen both the next day post stenting and at late follow up (p<0.05). No significant difference was seen in the improvement in dysphagia between the two groups (p>0.1). The frequency of complications encountered in the two groups was similar. Three patients in the Ultraflex group required two stents at primary stenting. Conclusion: The two types of stent are equally effective in the palliation of dysphagia associated with lower third oesophageal malignancy and the complication rates associated with their use are comparable.

Self-expanding Polyflex plastic stents in esophageal disease: various indications, complications, and outcomes

“…In patients with stent placement across the GEJ, the migration rate was even higher (45.4%, 5/11 patients with placement across the GEJ). Compared with migration rates reported for covered metallic stents, the migration frequency of SEPS seems to be increased [11,18,20]. However, the migration rates of SEMS are up to 50% when the stent is placed across the GEJ [1,25], which is comparable to our results.…”

“…The most important long-term complication is tumor ingrowth which becomes less frquent since membrane-covered SEMS are used. However, unfortunately the covering of the stents is accompanied by a higher incidence of stent migration [1,18,19].…”

Palliative therapy

“…In another prospective trial, the Ultraflex stent and the Flamingo Wallstent were compared in patients with distal esophageal cancer. The two stent types were equally effective in the palliation of dysphagia in this patient group, and the complication rate associated with their use was also comparable (Ultraflex stent: 7/31 (23%) and Flamingo Wallstent: 5/22 (23%)) [29].…”

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

“…Comparative studies of various types of self-expanding oesophageal stents reported similar rates of efficacy and complications. [175][176][177][178][179][180] Immediate haemorrhage rates are low, but consideration should be given to delayed severe haemorrhage, and this is likely to be a particular risk in patients on APA or anticoagulant therapy.…”