Feasibility and Safety of Through-the-scope versus Over-the-wire Stents for the Palliation of Malignant Dysphagia. A Cohort Real- Life Study.

Background and aims: In the presence of malignant dysphagia in non-surgical candidates, a self-expanding metal stent (SEMS) represents a safe and effective approach. Recently, a through-the-scope (TTS) SEMS was launched. The aim of our study was to assess the feasibility and safety of the TTS versus over-the-wire (OTW) SEMS in patients with malignant dysphagia.

Methods: This single-center retrospective cohort study included patients with malignant dysphagia undergoing esophageal TTS and OTW-SEMS from 2012 to May-2022. The primary outcomes were the technical and the clinical success of the SEMS placement. Secondary outcomes included adverse events, patency, and survival. Patients were prospectively followed until death or loss of follow-up.

Results: A total of 98 patients were enrolled, including 34 patients in the TTS group and 64 patients in the OTW group. TTS and OTW SEMS placement were feasible in 33 (97.1%) and 64 (100%) procedures , respectively (p=0.118). Overall, 32 patients (94.1%) in the TTS group and 62 patients (96.9%) in the OTW group showed an improvement in Ogilvie score (p=0.432). Recurrent dysphagia occurred in 30 patients, 12 in TTS group and 18 in OTW group, due to migration (4 vs. 5), stent deformation (1 vs. 1), tissue ingrowth (5 vs. 5) and overgrowth (2 vs. 7). No patient died from a stent-related cause. Median survival was 123 days (IQR: 59-209) in TTS group and 113 days (IQR: 73-271) in OTW group (p=0.349).

Conclusions: Placement of esophageal TTS and OTW stents resulted in similar technical and clinical outcomes, stent patency and survival in patients with malignant dysphagia.