Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy

Kirsten J. Kinsman, Barry T. DeGregorio, Ronald Katon, Katherine Morrison, Richard R. Saxon, Frederick Keller, Josef Rosch

Research output: Contribution to journalArticle

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Abstract

Background: Self-expanding metallic stents (SEMS) are effective in relieving the symptoms of obstructing esophagogastric malignancy. While complications with SEMS have been described, factors influencing such occurrence have not been defined. Methods: Self-expanding Gianturco-Rösch Z-stents were placed successfully in 59 patients with obstructing esophagogastric malignancies. Results: Early procedure-related complications occurred in 6 patients (10%) and were usually minor. Twenty-three late complications occurred in 22 patients (37.5%). Life-threatening complications occurred in 9 patients (15%), including gastrointestinal bleeding (7), perforation (1), and tracheoesophageal fistula (1) and contributed to all five deaths. Eight of 22 patients with prior radiation and/or chemotherapy (36.4%) had life-threatening complications compared to 1 or 37 (2.5%) without prior therapy (p=0.001). Stent-related mortality occurred in 5 of 22 (23%) patients with prior therapy compared to none of the 37 without prior therapy (p=0.005). Multivariate analysis confirmed the association between prior radiation and/or chemotherapy and life-threatening complications (p=0.012; odds ratio, 32.63) and also an association with female gender (p=0.032; odds ratio, 13.9). There was no association with tumor location or length, histologic type, age, prestent dysphagia grade, or previous surgical resection. Conclusion: Patients with prior radiation and/or chemotherapy have an increased risk of severe complications following placement of SEMS.

Original languageEnglish (US)
Pages (from-to)196-203
Number of pages8
JournalGastrointestinal Endoscopy
Volume43
Issue number2 PART 2
StatePublished - 1996
Externally publishedYes

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Stents
Radiation
Drug Therapy
Neoplasms
Odds Ratio
Tracheoesophageal Fistula
Deglutition Disorders
Therapeutics
Multivariate Analysis
Hemorrhage
Mortality

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy. / Kinsman, Kirsten J.; DeGregorio, Barry T.; Katon, Ronald; Morrison, Katherine; Saxon, Richard R.; Keller, Frederick; Rosch, Josef.

In: Gastrointestinal Endoscopy, Vol. 43, No. 2 PART 2, 1996, p. 196-203.

Research output: Contribution to journalArticle

Kinsman, Kirsten J. ; DeGregorio, Barry T. ; Katon, Ronald ; Morrison, Katherine ; Saxon, Richard R. ; Keller, Frederick ; Rosch, Josef. / Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy. In: Gastrointestinal Endoscopy. 1996 ; Vol. 43, No. 2 PART 2. pp. 196-203.
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abstract = "Background: Self-expanding metallic stents (SEMS) are effective in relieving the symptoms of obstructing esophagogastric malignancy. While complications with SEMS have been described, factors influencing such occurrence have not been defined. Methods: Self-expanding Gianturco-R{\"o}sch Z-stents were placed successfully in 59 patients with obstructing esophagogastric malignancies. Results: Early procedure-related complications occurred in 6 patients (10{\%}) and were usually minor. Twenty-three late complications occurred in 22 patients (37.5{\%}). Life-threatening complications occurred in 9 patients (15{\%}), including gastrointestinal bleeding (7), perforation (1), and tracheoesophageal fistula (1) and contributed to all five deaths. Eight of 22 patients with prior radiation and/or chemotherapy (36.4{\%}) had life-threatening complications compared to 1 or 37 (2.5{\%}) without prior therapy (p=0.001). Stent-related mortality occurred in 5 of 22 (23{\%}) patients with prior therapy compared to none of the 37 without prior therapy (p=0.005). Multivariate analysis confirmed the association between prior radiation and/or chemotherapy and life-threatening complications (p=0.012; odds ratio, 32.63) and also an association with female gender (p=0.032; odds ratio, 13.9). There was no association with tumor location or length, histologic type, age, prestent dysphagia grade, or previous surgical resection. Conclusion: Patients with prior radiation and/or chemotherapy have an increased risk of severe complications following placement of SEMS.",
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T1 - Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy

AU - Kinsman, Kirsten J.

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AU - Morrison, Katherine

AU - Saxon, Richard R.

AU - Keller, Frederick

AU - Rosch, Josef

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N2 - Background: Self-expanding metallic stents (SEMS) are effective in relieving the symptoms of obstructing esophagogastric malignancy. While complications with SEMS have been described, factors influencing such occurrence have not been defined. Methods: Self-expanding Gianturco-Rösch Z-stents were placed successfully in 59 patients with obstructing esophagogastric malignancies. Results: Early procedure-related complications occurred in 6 patients (10%) and were usually minor. Twenty-three late complications occurred in 22 patients (37.5%). Life-threatening complications occurred in 9 patients (15%), including gastrointestinal bleeding (7), perforation (1), and tracheoesophageal fistula (1) and contributed to all five deaths. Eight of 22 patients with prior radiation and/or chemotherapy (36.4%) had life-threatening complications compared to 1 or 37 (2.5%) without prior therapy (p=0.001). Stent-related mortality occurred in 5 of 22 (23%) patients with prior therapy compared to none of the 37 without prior therapy (p=0.005). Multivariate analysis confirmed the association between prior radiation and/or chemotherapy and life-threatening complications (p=0.012; odds ratio, 32.63) and also an association with female gender (p=0.032; odds ratio, 13.9). There was no association with tumor location or length, histologic type, age, prestent dysphagia grade, or previous surgical resection. Conclusion: Patients with prior radiation and/or chemotherapy have an increased risk of severe complications following placement of SEMS.

AB - Background: Self-expanding metallic stents (SEMS) are effective in relieving the symptoms of obstructing esophagogastric malignancy. While complications with SEMS have been described, factors influencing such occurrence have not been defined. Methods: Self-expanding Gianturco-Rösch Z-stents were placed successfully in 59 patients with obstructing esophagogastric malignancies. Results: Early procedure-related complications occurred in 6 patients (10%) and were usually minor. Twenty-three late complications occurred in 22 patients (37.5%). Life-threatening complications occurred in 9 patients (15%), including gastrointestinal bleeding (7), perforation (1), and tracheoesophageal fistula (1) and contributed to all five deaths. Eight of 22 patients with prior radiation and/or chemotherapy (36.4%) had life-threatening complications compared to 1 or 37 (2.5%) without prior therapy (p=0.001). Stent-related mortality occurred in 5 of 22 (23%) patients with prior therapy compared to none of the 37 without prior therapy (p=0.005). Multivariate analysis confirmed the association between prior radiation and/or chemotherapy and life-threatening complications (p=0.012; odds ratio, 32.63) and also an association with female gender (p=0.032; odds ratio, 13.9). There was no association with tumor location or length, histologic type, age, prestent dysphagia grade, or previous surgical resection. Conclusion: Patients with prior radiation and/or chemotherapy have an increased risk of severe complications following placement of SEMS.

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