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 M. Katon, Katherine Morrison, Richard R. Saxon, Frederick S. Keller, Josef Rösch

Research output: Contribution to journalArticlepeer-review

203 Scopus citations

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
DOIs
StatePublished - 1996

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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