Stent Type Used Does Not Impact Complication Rate or Placement Time but Can Decrease Treatment Cost for Benign and Malignant Esophageal Lesions

Abstract

Purpose: Esophageal obstruction occurs from either intrinsic or extrinsic etiologies. Intrinsic causes are more common and largely due to malignancy. The majority of esophageal cancer patients are not resection candidates, requiring palliative stent placement. SEMS (self-expanding metal stents) are thought to be preferable to SEPS (self-expanding plastic stents) for palliation of malignant disease due to perceived decreased technical difficulties and stent migration rates. Data using SEPS in benign disease are mixed and report success rates between 17-95%. In addition, SEPS are not routinely recommended due to complications. The aim of the study was to retrospectively compare safety, efficacy, clinical outcomes and placement ease of SEMS and SEPS in benign or malignant esophageal stenosis. Methods: All patients at UFCOM-Jacksonville endoscopy laboratory having EGD with stent placement for benign or malignant esophageal stenosis between January 2005 and April 2012 were eligible for study. Patients without stent placement at the completion of EGD were excluded. Data collected included patient demographics, procedure time, stent cost and clinical outcomes (technical success of stent placement, procedure-related complications, need for subsequent re-intervention, length of hospital stay and mortality). Results: Forty-three patients underwent stent placement for either benign or malignant disease during the study period. SEMS were placed in 30 patients (25 male, mean age 59.6 yrs old) and SEPS were used in 13 patients (10 male, mean age 61.7 yrs old). Placement outcome of SEPS compared to SEMS did not differ statistically. Complication rate in the SEPS group was 23.1% compared with 25.2% in the SEMS group. Stent migration was the most frequent complication, occurring in 66.7% in the SEPS group compared with 57.1% in the SEMS group. In-hospital mortality was also similar: 7.7% (SEPS) compared with 6.7% (SEMS). Procedure time, need for re-intervention, survival after procedure, length of hospital stay and time to first complication were also not significantly different between SEPS and SEMS groups. Interestingly, metal stents were more expensive than plastic stents with an institution cost difference of approximately $205/stent and even higher patient costs. Conclusion: SEPS and SEMS placement produced similar outcomes for either benign or malignant esophageal occlusion. SEPS are less costly than SEMS and it may be more practical to initially use SEPS due to this factor. If all patients who received SEMS had SEPS placed instead, a significant cost reduction would be realized for this patient cohort.