Konsekutiver Vergleich von 3 verschiedenen Typen selbstexpandierender Metallstents zur Palliation der malignen Dysphagie: Ergebnisse aus dem prospektiven Ludwigshafener Ösophagus-Stentregister

Zusammenfassung

Hintergrund: Das endoskopische Stenting mit selbstexpandierenden Metallstents (SEMS) hat sich als palliative endoskopische Therapieoption bei maligner Dysphagie bewährt. Verschiedene Typen von SEMS wurden bislang in kleineren randomisierten Studien untersucht. Methodik: Von 1/1995 - 1/2004 wurden insgesamt 150 konsekutive Patienten (Pt.) (35 Frauen, 115 Männer), medianes Alter 66 (43 - 94) Jahre in die Auswertung eingeschlossen. Drei Typen von SEMS kamen zum Einsatz: (Gruppe A: Gianturco-Z®-Stent, n = 59 Pt.; Gruppe B: Ultraflex®-Stent, n = 49 Pt.; Gruppe C: Flamingo-Wallstent®, n = 42 Pt.). Die Dysphagie wurde in Schweregrad 0 (keine Dysphagie) bis Schweregrad 4 (totale Obstruktion) eingeteilt. Ergebnisse: Eine erfolgreiche Stenteinlage wurde bei 55/59 (93 %) Pt. der Gruppe A, 47/49 (96 %) Pt. der Gruppe B und 40/42 (95 %) Pt. der Gruppe C evaluiert (p = 0,78). Postinterventionell konnte eine Reduktion des Dysphagiescore in Gruppe A (von 2,77 auf 0,99), Gruppe B (2,58 auf 0,72) und Gruppe C (2,62 auf 0,81) verzeichnet werden (p = 0,37). Patienten der Gruppe B zeigten eine tendenziell längere Dysphagiefreiheit (Gruppe A: 78 Tage, Gruppe B: 90 Tage, Gruppe C: 70 Tage) (p = 0,45). Das mediane Überleben lag bei 96 Tagen (Gruppe A), 118 Tagen (Gruppe B) und 108 Tagen (Gruppe C) (p = 0,18). Höhergradige Komplikationen boten 20/59 (34 %) Pt. der Gruppe A, 8/49 (16 %) und 7/42 (17 %) Pt. der Gruppen B und C (p = 0,04). Schlussfolgerungen: In der Behandlung der malignen Dysphagie zeigten alle 3 untersuchten SEMS-Typen eine vergleichbare Effektivität. Allerdings war der Gianturco-Z®-Stent im Vergleich zum Ultraflex®-Stent und zum Flamingo-Wallstent® mit einer signifikant höheren Komplikationsrate verbunden.

Abstract

Background: Endoscopic stenting with self-expanding metal stents (SEMS) has proved to be an efficient palliative endoscopic therapy option in treating malignant dysphagia. Different types of SEMS have been examined previously in small randomized clinical trials. Methods: A total of 150 consecutive patients (from 1/1995 - 1/2004; 35 females, 115males) with a median age of 66 years (range 43 - 94 years) were evaluated. Three different types of SEMS were examined: Group A: Gianturco Z® Stent n = 59 pts.; Gruppe B: Ultraflex® Stent n = 49 pts.; Gruppe C: Flamingo Wallstent® n = 42 pts.). Dysphagia was categorized into grade 0 (no dysphagia) to grade 4 (total obstruction). Results: Stent insertion was successfully evaluated in 55/59 (93 %) of the patients in group A, in 47/49 (96 %) of the patients in group B and in 40/42 (95 %) of the patients in group C (p = 0.78). After stent insertion, a reduction in the dysphagia score from 2.77 to 0.99 was observed in group A, from 2.58 to 0.72 in group B and from 2.62 to 0.81 in group C (p = 0.37). The median time to dysphagia recurrence was 78 days in group A, 90 days in group B and 70 days in group C (p = 0.45). The median overall survival time was 96 days in group A, 118 days in group B and 108 days in group C (p = 0.18). The incidence of high grade complications was 34 % in group A, 16 % in group B and 17 % in group C (p = 0.04). Conclusions: The 3 types of SEMS examined in this study showed similar efficacies in treating malignant dysphagia. However, the major complication rate of the Gianturco Z® stent was significantly higher when compared to the complication rate of the Ultraflex® stent and the Flamingo Wallstent®.

Selbstexpandierende Metallstents (SEMS) - maligne Dysphagie - Palliation - endoskopische Stenttherapie

Self-expanding metal stents (SEMS) - malignant dysphagia - palliation - endoscopic stenting

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