Original article
Clinical endoscopy
Changing epidemiology of esophageal stent placement for dysphagia: a decade of trends and the impact of benign indications

https://doi.org/10.1016/j.gie.2020.02.018Get rights and content

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.

Section snippets

Data source

The National Inpatient Sample (NIS) is part of the Healthcare Cost Utilization Project and the largest publicly available database in the United States.19 The NIS has unweighted data from more than 8 million hospital stays that represent a weighted estimate of 35 million hospitalizations every year. The database is able to provide national estimates of patient demographics, hospital characteristics, procedures performed, and discharge diagnoses based on a 20% stratified probability sample.

Temporal trends for ES placement in patients with dysphagia

Between 2003 and 2013, among 21,522 ESs placed in hospitalized patients, 7198 were placed endoscopically for those with an ICD-9-CM code of dysphagia (Table 1). The remaining 14,324 patients (39% for nonmalignant etiology) were excluded because of a lack of ICD-9-CM code for dysphagia during their hospitalization when the ES was placed (Supplementary Table 3, available online at www.giejournal.org). There was a significant increase in the rate of endoscopic ES placement for patients with

Discussion

In this population-based study, we have evaluated national trends for endoscopic placement of ESs in hospitalized patients with dysphagia. The number of ESs placed more than tripled between 2003 and 2013. Although the number of stents placed for benign indications increased over 8-fold, there was a modest 3-fold increase in stents for malignant indications as well. Adjusting for multiple demographic and hospital variables, the increase in benign indications was significantly associated with ES

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    DISCLOSURE: All authors disclosed no financial relationships.

    If you would like to chat with an author of this article, you may contact Dr Krishna at [email protected].

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