Covered metallic stent versus silicone stent for malignant esophagorespiratory fistula: A single-center retrospective cohort study
L. Lina (Mr), J. Zenga (Ms), Z. Chena (Mr), M. Ke*a (Dr)
a Xiamen Medical College Affiliated Second Hospital, Xiamen, CHINA
* 13860166866@126.com
Background: Malignant esophagorespiratory fistulas is an intractable and fatal disease. We aimed to compare the efficacy and safety of covered metallic stent and silicone stent for malignant ERF.
Method: We retrospectively reviewed data of patients with malignant esophagorespiratory fistulas who underwent placement of metallic stent or silicone stent at our study site between November 2011 and February 2021. The primary outcome was the clinical success rate. Safety was also monitored.
Results: There were 218 patients met our inclusion and exclusion criteria, 92 were included in covered metallic stent group and 126 in silicone stent group. The median follow-up duration was 78.0 days (95%CI: 62.5 - 93.5). The clinical success rate was numerically lower in covered metallic stent group (84.7% vs. 90.7%, P=0.20). The dyspnea scale in both groups was significantly improved after stenting, but no between-group difference in the change of dyspnea scale was detected (P=0.80). The stents were removed for the healed fistula in 16 patients (5 in metallic stent and 11 in silicon stent, P=0.7). Silicone stent yielded a markedly longer survival duration (98.0 days, 95%CI: 48.8- 147.2) than covered metallic stent group (52.0 days, 95%CI: 34.0 - 70.1) (P=0.01). Multivariate logistic regression analysis showed, none of the fistula size, PS score and history of radiotherapy was the risk factor for survival. The overall rate of complication was similar in two groups. Rupture of stent membrane and mesh fracture only took place in metallic stent group.
Conclusion: Silicone stent is non-inferior to covered metallic stent for palliative treatment and could effectively manage malignant esophagorespiratory fistulas. Placement of both stents are well tolerated.
Disclosure of funding source(s): none