Fully vs. partially covered selfexpandable metal stent for palliation of malignant esophageal strictures: a randomized trial (the COPAC study)

Paul Didden, Agnes N Reijm, Nicole S Erler, Leonieke M M Wolters, Thjon J Tang, Pieter C J Ter Borg, Ivonne Leeuwenburgh, Marco J Bruno, Manon C W Spaander

Research output: Contribution to journalArticleAcademicpeer-review

19 Citations (Scopus)

Abstract

BACKGROUND: Covered esophageal self-expandable metal stents (SEMSs) are currently used for palliation of malignant dysphagia. The optimal extent of the covering to prevent recurrent obstruction is unknown. Therefore, we aimed to compare fully covered (FC) versus partially covered (PC) SEMSs in patients with incurable malignant esophageal stenosis.

METHODS: In this multicenter randomized controlled trial, 98 incurable patients with dysphagia caused by a malignant stricture of the esophagus or cardia were randomized 1:1 to an FC-SEMS or PC-SEMS. The primary outcome was recurrent obstruction after endoscopic SEMS placement. Secondary outcomes were technical and clinical success, adverse events, and health-related quality of life (HRQoL). Patients were followed until 6 months after SEMS placement or to SEMS removal, second SEMS insertion, or death, whichever came first.

RESULTS: Recurrent obstruction after SEMS placement was similar for both types of stents: 19 % for FC-SEMSs and 22 % for PC-SEMSs (P = 0.65). The times to recurrent obstruction did not differ. The frequency of adverse events was similar between the two groups, with major adverse events occurring in 38 % and 47 % of patients for FC-SEMSs and PC-SEMSs, respectively (P = 0.34). No significant differences were seen in technical success, improvement of dysphagia, and HRQoL. Proximal esophageal stenosis and female sex were independently associated with recurrent obstruction and/or major adverse events.

CONCLUSIONS: Esophageal FC-SEMSs did not reveal a lower recurrent obstruction rate compared with PC-SEMSs in the palliative management of malignant dysphagia.

Original languageEnglish
Pages (from-to)961-971
Number of pages11
JournalEndoscopy
Volume50
Issue number10
DOIs
Publication statusPublished - Oct 2018
Externally publishedYes

Keywords

  • Aged
  • Aged, 80 and over
  • Deglutition Disorders/etiology
  • Endoscopy, Gastrointestinal
  • Esophageal Neoplasms/complications
  • Esophageal Stenosis/etiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Palliative Care
  • Prosthesis Failure
  • Quality of Life
  • Recurrence
  • Self Expandable Metallic Stents/adverse effects
  • Treatment Outcome

Fingerprint

Dive into the research topics of 'Fully vs. partially covered selfexpandable metal stent for palliation of malignant esophageal strictures: a randomized trial (the COPAC study)'. Together they form a unique fingerprint.

Cite this