Combination of biodegradable stent placement and single-dose brachytherapy is associated with an unacceptably high complication rate in the treatment of dysphagia from esophageal cancer

BACKGROUND: Placement of self-expanding metallic esophageal stent in patients with advanced esophageal cancer offers excellent palliation of dysphagia and tracheo-esophageal fistulas. However, the safety of stent in patients undergoing radio and/or chemotherapy is controversial, in terms of the greater risk of complications in cases where these two treatments are used in conjunction. AIM: To assess the use of stent in patients with advanced cancer of the mid-thoracic esophagus, by comparing patients undergoing cytoreductive therapy with patients who have not undergone this treatment, in relation to improvement in the dysphagia, rate of complications, period of effectiveness and survival time. METHODS: Fifty seven patients were evaluated retrospectively (16 women and 41 men, with an average age 62 years) with advanced squamous cell carcinoma of the mid-thoracic esophagus who underwent placement of the Ultraflex™ self-expandable metallic coated stent, at the Gastrointestinal Endoscopy Unit of São Paulo University Medical School between October 1988 and October 2004. Out of the 57 patients, 24 patients received adjuvant cytoreductive therapy, and 33 patients were only treated with the stent placement. RESULTS: After stent placement, there was improvement in dysphagia in both groups; there were no differences in the rate of complications, such as migration, pain, fistula, obstruction and compression of the airways; the period of effectiveness was significantly higher in the group submitted to cytoreductive therapy (average 123 days compared to 63 days), as was the survival time (average of 210 days, compared with 120 days). CONCLUSIONS: Improvement in dysphagia was statistically significant in both groups, irrespective of whether the patient had undergone adjuvant cytoreductive therapy; there were no differences in the rate of complications between the two groups and both the period of effectiveness of the stent treatment and the survival time were higher in the group with adjuvant cytoreductive therapy.

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High complication rate after septic orthopaedic implant removal of the lower leg

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-014-2093-6 ◽

2014 ◽

Vol 134 (12) ◽

pp. 1655-1660 ◽

Cited By ~ 2

Author(s):

A. J. Suda ◽

K. A. Winkler ◽

P. A. Grützner ◽

P. C. Thoele ◽

V. G. Heppert ◽

...

Keyword(s):

Complication Rate ◽

Lower Leg ◽

Implant Removal ◽

Orthopaedic Implant ◽

High Complication Rate

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Development of severe complications caused by stent placement followed by definitive radiation therapy for T4 esophageal cancer

International Journal of Clinical Oncology ◽

10.1007/s10147-003-0356-2 ◽

2003 ◽

Vol 8 (6) ◽

pp. 395-398 ◽

Cited By ~ 29

Author(s):

Masahiro Yakami ◽

Michihide Mitsumori ◽

Heitetsu Sai ◽

Yasushi Nagata ◽

Masahiro Hiraoka ◽

...

Keyword(s):

Esophageal Cancer ◽

Radiation Therapy ◽

Stent Placement ◽

T4 Esophageal Cancer

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Dilation or biodegradable stent placement for recurrent benign esophageal strictures: a randomized controlled trial

Endoscopy ◽

10.1055/a-0602-4169 ◽

2018 ◽

Vol 50 (12) ◽

pp. 1146-1155 ◽

Cited By ~ 6

Author(s):

Daisy Walter ◽

Maarten van den Berg ◽

Meike Hirdes ◽

Frank Vleggaar ◽

Alessandro Repici ◽

...

Keyword(s):

Stent Placement ◽

Controlled Trial ◽

Treatment Algorithm ◽

Stent Group ◽

Biodegradable Stent ◽

Recurrent Stricture ◽

Level Of Activity ◽

Number Of Patients ◽

Esophageal Strictures ◽

Biodegradable Stents

Abstract Background Dilation is the standard of care for recurrent benign esophageal strictures (BES). Biodegradable stents may prolong the effect of dilation and reduce recurrences. Efficacy and safety of dilation and biodegradable stent placement early in the treatment algorithm of recurrent BES were compared. Methods This multicenter, randomized study enrolled patients with BES treated with previous dilations to ≥ 16 mm. The primary end point was number of repeat endoscopic dilations for recurrent stricture within 3 and 6 months. Secondary outcomes through 12 months included safety, time to first dilation for recurrent stricture, dysphagia, and level of activity. Results At 3 months, the biodegradable stent group (n = 32) underwent significantly fewer endoscopic dilations for recurrent stricture compared with the dilation group (n = 34; P < 0.001). By 6 months, the groups were similar. The number of patients experiencing adverse events was similar between the groups. Two patients in the biodegradable stent group died after developing tracheoesophageal fistulas at 95 and 96 days post-placement; no deaths were attributed to the stent. Median time to first dilation of recurrent stricture for the biodegradable stent group was significantly longer (106 vs. 41.5 days; P = 0.003). Dysphagia scores improved for both groups. Patients in the biodegradable stent group had a significantly higher level of activity through 12 months (P < 0.001). Conclusion Biodegradable stent placement is associated with temporary reduction in number of repeat dilations and prolonged time to recurrent dysphagia compared with dilation. Additional studies are needed to better define the exact role of biodegradable stent placement to treat recurrent BES.

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