Management of inoperable malignant oesophageal strictures with fully covered WallFlex® stent: A multicentre prospective study

Background: The majority of currently available oesophageal metal stents are partially covered to reduce migration risk. Preliminary experiences with fully covered stents seem to indicate an increased risk of migration in patients treated for malignant dysphagia. The aim of our study was to determine, in this setting, the safety and efficacy of a new, recently introduced stent with anti-migration proprieties. Methods: We designed a prospective, multicentre, non-randomized, follow-up study in nine tertiary referral centres. Eighty-two patients with dysphagia due to inoperable or metastatic oesophageal cancer were included. In all of them the fully covered WallFlex (R) stent was placed. Main outcome measurements included functional outcome, recurrent dysphagia, complications, and mortality. Results: Dysphagia score improved from a median of 3, before stenting, to 1 at 4 weeks after stent placement (P < 0.001). Perforation occurred in 1 patient after 39 days, while bleeding was reported in 3. In total, 19 patients (23.1%) developed recurrent dysphagia because of stent migration (N = 10, 12.2%), tissue overgrowth (N = 7; 8.5%), and food impaction (N = 2; 2.4%). Conclusions: Placement of the fully covered WallFlex (R) stent resulted in safe and effective palliation of malignant dysphagia, with migration and tissue overgrowth rates comparable to previously reported data on partially covered stents. (C) 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.