Eyüp ŞENOL, Fahrettin KÜÇÜKAY, Mehmet YURDAKUL, Rıza S. ÖKTEN, Muharrem TOLA, MURAT BÜLENT KÜÇÜKAY, Adnan KARAN, MUSTAFA ÖZDEMİR, Fatma Ayça ÖZDEMİR EDİS

Comparison of covered and uncovered self-expanding metallic stents used in the palliative treatment of inoperable malignant esophageal strictures

Giriş ve Amaç: Bu çalışmanın amacı, inoperabl malign özefageal darlığın palyatif tedavisinde kullanılan, kendiliğinden genişleyen metalik stentlerin (self-expanding metal stent) etkinliğinin araştırılması ve kul- lanılan kaplı ve kapsız kendiliğinden genişleyen metalik stent tiplerinin karşılaştırılmasıdır. Gereç ve Yöntem: Non-curable malign özefageal striktür tanısı olan, palyatif tedavi için kliniğimize başvuran 62 hastaya, Şubat 2008 ve Kasım 2013 tarihleri arasında, floroskopi (Philips Integris Allura, Holland) kılavuzluğunda, kaplı ve kapsız kendiliğinden genişle- yen metalik stent uygulandı. Klinik etkinlik, işleme bağlı komplikasyonlar ve sağ kalım ile ilgili veriler retrospektif olarak toplandı Bulgular: Se- konder girişimler dahil 81 adet kendiliğinden genişleyen metalik stent %100 başarı ile implante edildi. İşlem öncesine oranla işlem sonrası dis- faji skoru, her iki stent tipinde de belirgin azalmıştır. İşleme bağlı mor- talite oranı %3,2 bulunmuştur. Sekonder girişim oranı %25,8 olup kap- lı-kapsız stent tipi ile sekonder girişimler arasında istatistiksel anlamlı bir ilişki saptanmamıştır. Sağ kalım açısından, kaplı ve kapsız kendiliğinden genişleyen metalik stent uygulanan hastalar arasında; ayrıca kemote- rapi-radyoterapi alan ve almayan hastalar arasında, istatistiksel anlamlı farklılık saptanmadı. Kendiliğinden genişleyen metalik stentlerin implan- tasyonundan sonra erken dönemde komplikasyon görülen hastalarda ve majör komplikasyonlar görülen hastalarda mortalite ve morbidite- nin daha yüksek olduğu izlendi. Ancak komplikasyon tipi ve dönemi ile uygulanan kaplı-kapsız kendiliğinden genişleyen metalik stentlerin tipi arasında istatistiksel anlamlı bir ilişki saptanmadı. Sonuç: Malign öze- fageal darlıkların palyatif tedavisinde kendiliğinden genişleyen metalik stentlerin, etkili ve güvenilir bir yöntem olduğunu söyleyebiliriz. Ancak uygulanan kaplı veya kapsız kendiliğinden genişleyen metalik stent tipinin, kemoterapinin ve radyoterapinin, mortalite ve morbiditeye anlamlı bir etkisinin olmadığını görmekteyiz.

İnoperabl malign özefageal darlığın palyatif tedavisinde kullanılan kaplı ve kapsız kendiliğinden genişleyen metalik stentlerin karşılaştırılması

Background and Aims: The aim of this study is to evaluate the effica- cy of self-expanding metallic stents used in the palliative treatment of inoperable malignant esophageal stenosis, and comparing covered vs. uncovered self-expanding metallic stent types. Materials and Meth- ods: In our study, 62 patients seen in our clinic for palliative treatment, received covered or uncovered self-expanding metallic stents under fluoroscopic (Philips Integris Allura, Holland) guidance for malignant esophageal strictures. The study was a retrospective analysis of the re- cords of these 62 patients who were treated between February 2008 and November 2013. Clinic ephicasis, complications related to the pro- cedure, and data related with morbidity and mortality were collected retrospectively. Results: A total of 81 self-expanding metallic stents, including secondary attempts, were successfully placed. Dysphagia scores decreased significantly after treatment in both covered and un- covered stent types compared to pre-procedure scores. A procedure-re- lated mortality rate of 3.2% was observed. Secondary intervention rate was 25.8%, and a statistically insignificant relationship was found be- tween covered vs. uncovered stent types and secondary interventions. No statistically considerable differences were observed in survival rates among patients with covered and uncovered self-expanding metallic stents, and among patients receiving and not receiving chemothera- py-radiotherapy. Mortality and morbidity were higher in patients who experienced complications in the early period following self-expanding metallic stent implantation and in patients with major complications. However, no statistically significant relationship was observed between covered vs. uncovered self-expanding metallic stent type, complication type or time period. Conclusion: Self-expanding metallic stent is an effective and reliable method in the palliative treatment of malignant esophageal stricture. Additionally, self-expanding metallic stent type as well as chemotherapy and radiotherapy have no considerable effect on mortality or morbidity in these patients.

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