Background and Aims

In addition to managing malignant obstruction, esophageal stents (ESs) have evolved to address various benign etiologies of dysphagia. We sought to evaluate national trends and changes in practice of ES placement for both benign and malignant etiologies in hospitalized patients with dysphagia.

Methods

The National Inpatient Sample (2003-2013) was used to include all adult inpatients (≥18 years of age) with endoscopy-guided ES placement for a symptom of dysphagia. Multivariable analyses for indications that impact temporal trends (3 time periods: 2003-2005, 2006-2009, and 2010-2013) and for hospital outcomes were performed.

Results

A total of 7198 ESs were deployed endoscopically in hospitalized patients with dysphagia. Compared with malignant etiologies, there was a significant increase in ES placement for benign conditions (2013 vs 2003: 32.7% vs 14.5%, respectively; P < .001). Multivariable analysis using 2003 to 2005 as a reference showed that patients with benign etiologies for dysphagia predominantly contributed to the increase of ES placement during the most recent time period (2010-2013: odds ratio, 2.09; 95% confidence interval, 1.40-3.13). Multivariable analysis of hospital outcomes revealed no differences in inpatient mortality, duration of hospital stay, and hospital costs between malignant and benign indications.

Conclusions

In the preceding decade, ES placement for hospitalized patients with dysphagia has increased, driven largely by an over 8-fold rise in stent placement for benign indications. These findings warrant continued efforts to improve stent technology to decrease the risk of migration and review practice guidelines involving ES placement for benign etiologies.

中文翻译：

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食管支架置入引起吞咽困难的流行病学变化：十年趋势和良性适应症的影响。

背景和目标

除处理恶性梗阻外，食管支架（ESs）已经发展为解决吞咽困难的各种良性病因。我们试图评估吞咽困难住院患者的良性和恶性病因的全国趋势和ES放置实践的变化。

方法

国家住院患者样本（2003-2013年）用于包括所有因吞咽困难症状在内窥镜检查引导下放置ES的成年住院患者（≥18岁）。进行了多变量分析，分析了影响时间趋势的迹象（3个时间段：2003-2005、2006-2009和2010-2013）以及医院的结果。

结果

共有7198例ES在内窥镜下用于吞咽困难的住院患者。与恶性病因相比，良性疾病的ES放置显着增加（2013年与2003年：分别为32.7％和14.5％；P  <.001）。以2003年至2005年为参考的多变量分析显示，吞咽困难的良性病因患者在最近一段时间内主要是导致ES放置增加（2010-2013：优势比，2.09； 95％置信区间，1.40-3.13） 。医院结局的多变量分析显示，恶性和良性适应症之间的住院死亡率，住院时间和住院费用均无差异。

结论

在过去的十年中，因吞咽困难住院的吞咽困难患者的ES放置增加了，这主要是由于良性适应症的支架放置增加了8倍以上。这些发现保证了继续努力以改善支架技术以降低迁移的风险，并回顾了良性病因涉及ES放置的实践指南。