Coated and uncoated self-expanding metal stents for malignant XXXX in the upper GI tract: preliminary clinical experiences with Wallstents.

@entity1 @entity5 @entity418 @entity1282 @entity158 @entity850
OBJECTIVES: The clinical feasibility of self-expanding metal stents with respect to the technical success, complications, and reintervention rate should be tested. METHODS: Five coated and 26 uncoated prototype Wallstents, especially designed for @entity850 of the upper GI tract, were implanted in 23 @entity1 . All @entity1 with @entity1282 suffered from inoperable @entity5 @entity850 of the esophagus or the @entity418 . Stent implantation was performed under slight i.v. sedoanalgesia. RESULTS: Technical success was achieved in all 31 implanted stents. Forty-eight hr after implantation, @entity1282 was improved in 21/23 @entity1 . Acute problems observed within 1 wk were stent migration (1 @entity1 , uncoated stent), oblique position of the stent (3 @entity1 ), epigastric or @entity158 (9 @entity1 ), insufficient stent expansion (4 @entity1 ), and pouch formation at the upper rim of the stent (4 @entity1 ). An uncomplicated follow-up (median 66 days, range 10-139 days) was seen in 12 @entity1 (52%). Major problems in the follow-up period were stent migration in three @entity1 (three coated stents, two stent migrations in one @entity1 ) and stent obstruction by @entity5 ingrowth/overgrowth and/or food impaction in eight @entity1 (35%). Most of these problems could be successfully resolved by implantation of a second stent or electrocoagulation of overgrowing @entity5 tissue. By the 1st of March, 1994, three @entity1 were still alive with a follow-up period of 530 days (median range, 336-880 days); 20 @entity1 were decreased with a follow-up period of 70 days (median range, 3-374 days). CONCLUSIONS: Implantation of esophageal Wallstents is safe and has a low risk of acute complications and mortality for the @entity1 . Early complications such as perforation and bleeding did not occur. @entity5 ingrowth/overgrowth are the major reasons for the high reintervention rate in the follow-up period. Coated stents can resolve this problem, provided that stent migration can be avoided by improvement of the coating technology.
