Esophageal stents with antireflux valve for tumors of the distal esophagus and gastric cardia: a randomized trial

Homs, Marjolein Y.V.; Wahab, Peter J.; Kuipers, Ernst J.; Steyerberg, Ewout W.; Grool, T.A.; Haringsma, Jelle; Siersema, Peter D.

doi:10.1016/s0016-5107(04)02047-4

Cited by 105 publications

(74 citation statements)

References 24 publications

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“…1). A few studies have been reported using different types of anti-reflux stents (Table III) [31][32][33][34][35]. The first results with a modified Zstent with a windsock-type anti-reflux valve were reported in a study including 11 patients.…”

Section: Consmentioning

confidence: 99%

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Palliative therapy

Homs

Kuipers

Siersema

2005

Journal of Surgical Oncology

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There are a wide variety of palliative treatments for esophageal cancer. The aim of most treatments is to maintain oral food intake, which should stabilize or even improve quality of life. Stent placement is currently the most widely used treatment modality for palliation of dysphagia from esophageal cancer. Stent placement offers a rapid relief of dysphagia, however, the rate of complications (late hemorrhage) and recurrent dysphagia (stent migration, tumor overgrowth) is relatively high. The scientific evidence to advocate the use of anti-reflux stents for the prevention of gastro-esophageal reflux is currently too low. Photodynamic therapy is mostly used in North America; however, due to the high costs of the treatment, the long-lasting side effects and the necessity of repeated treatments, it is not an ideal treatment for palliation of malignant dysphagia. Nd:YAG laser is a relatively effective and safe treatment modality, although laser treatment is also expensive, technically difficult and requiring repeated treatment sessions at 4-6 weeks intervals. Single dose brachytherapy compares favorably to stent placement in long-term effectiveness and safety. Effective treatment strategies are probably 12 Gy given in one fraction or 16 Gy given in two fractions. Palliative chemotherapy offers response rates in recent trials (including partial and complete responses) ranging from 35% to 50%. Whether palliative chemotherapy also results in a survival benefit is not established yet. For clinical trials on palliation of esophageal cancer, the measurement of quality of life is an important outcome measure. The cancer-specific EORTC QLQ-C30 and the esophageal cancer-specific EORTC-OES-18 are validated measures for establishing quality of life status. For the future, a multimodality approach with stent placement or brachytherapy in combination with chemotherapy may be indicated.

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Section: Consmentioning

confidence: 99%

“…Unfortunately, in both studies, this measurement succeeded in only a part of the study population [31,33]. In a randomized study, comparing the FerX-Ella stent with ''windsock-type'' anti-reflux valve with an open FerX-Ella stent, 24-hr pH-monitorings still showed increased esophageal acid exposure with the anti-reflux stent [31].…”

Section: Consmentioning

confidence: 99%

Palliative therapy

Homs

Kuipers

Siersema

2005

Journal of Surgical Oncology

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“…This therapy has increased in popularity during recent years because it effectively and rapidly relieves dysphagia and has proved to be safe and minimally invasive [7,13,14]. However, stent treatment of patients with a malignant tumor at or near the esophagogastric junction is more complex than management of more proximal tumors because placement of a standard open stent across this junction may result in severe gastroesophageal reflux and pulmonary aspiration [5]. Severe heartburn and respiratory symptoms are reported to occur in about one-third of patients who have received a stent for a malignant stricture at this site [12].…”

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confidence: 99%

An antireflux stent versus conventional stents for palliation of distal esophageal or cardia cancer: a randomized clinical study

et al. 2006

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“…The modified self-expanding metallic stents with antireflux mechanism were introduced by researchers and achieved good results in preventing gastroesophageal reflux [30,31,32]. The stent used in this study had an antireflux valve (fig.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Efficacy of Pneumatic Dilation and Esophageal Stenting for the Treatment of Achalasia

Qian

Wang

et al. 2013

Digestion

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Aims: To compare the efficacy and safety of pneumatic dilation with stenting for the treatment of achalasia. Methods: Achalasia patients treated with pneumatic dilation or stenting were included in this analysis. Clinical symptoms were assessed by the Eckardt score. An esophagram and esophageal manometry were performed at the pretreatment and posttreatment follow-up visits. Data such as patient demographics and complications were collected. A drop in the Eckardt score to ≤3 was defined as treatment success. Results: There were 151 patients treated with pneumatic dilation (n = 76) or stenting (n = 75). The 1-, 12- and 24-month therapeutic success rates were 100, 92 and 79%, respectively, in the dilation group and 100, 93 and 87%, respectively, in the stenting group. The decrease of Eckardt score in the stenting group was significantly notable (p < 0.05) compared to that of the dilation group at the long-term follow-up visits. The maximum esophageal diameter was comparable at baseline and became statistically significant [25 mm (22-30) vs. 22 mm (19-27), p = 0.004] at posttreatment month 24. The recurrence rate was 21% in the dilation group and 13% in the stenting group. The complications of either treatment were usually mild, transient and statistically insignificant. Conclusion: Esophageal stenting had a comparable short-term but better long-term efficacy in comparison with pneumatic dilation.

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Esophageal stents with antireflux valve for tumors of the distal esophagus and gastric cardia: a randomized trial

Cited by 105 publications

References 24 publications

Palliative therapy

Palliative therapy

An antireflux stent versus conventional stents for palliation of distal esophageal or cardia cancer: a randomized clinical study

Long-Term Efficacy of Pneumatic Dilation and Esophageal Stenting for the Treatment of Achalasia

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