Esophageal Stenting in Clinical Practice: an Overview

Abstract

Opinion statementPurpose of reviewEsophageal stents are used in clinical practice for endoscopic treatment of a wide variety of esophageal diseases and conditions. This review provides key principles and a literature update on the utility and limitations of esophageal stenting in clinical practice.Recent findingsIndications for esophageal stenting can be subdivided into two groups. The first group consists of patients with malignant or benign dysphagia, in which an esophageal stent restores luminal patency. In the past years, temporary stent placement has increasingly been used in the therapeutic management of refractory benign esophageal strictures. When endoscopic repeated bougie dilation and other endoscopic treatment modalities have failed, an esophageal stent could be considered. Based on the literature, a fully covered self-expandable metal stent may be the preferred choice for the treatment of both malignant and benign dysphagia. The second group consists of patients with leakage from the esophageal lumen into the surrounding tissue. Esophageal leakage can be subdivided into three forms, benign esophageal perforations (iatrogenic and spontaneous), anastomotic leakage after reconstructive esophageal surgery, and fistula. In a carefully selected group of patients, a covered esophageal stent may be used for sealing off the leakage, thereby preventing further contamination of the tissue surrounding the defect. The past few years, several validated prediction tools have been developed that may assist clinicians in the selection of patients eligible for esophageal stent placement. Based on retrospective studies and expert opinion, a partially or fully covered self-expandable metal stent may have a role in treatment of esophageal leakage.SummaryResearch do date supports the utilization of esophageal stents for the treatment of malignant or benign dysphagia and esophageal leakage.

Biodegradable esophageal stents for the treatment of refractory benign esophageal strictures

“…While self-expandable stents (metallic or plastic) are effective for malignant indications [3], they are not globally accepted for the treatment of benign esophageal diseases, since they are associated with a significant risk of adverse events [4]. Uncovered or partially covered metal stents are prone to tissue overgrowth that may result in stent obstruction [5,6]. Additional interventions are then needed to treat the overgrowth tissue or to place another stent, aiming to restore stent patency [7,8].…”

Covered Metal Stent after Dysfunction of Uncovered Stents for Palliation of Gastrointestinal Malignant Obstruction

“…The stent-in-stent technique, with placement of cSEMS after uSEMS, has already been described in obstructions of the esophagus for both stent removal in benign conditions and for palliative therapy of malignant obstructions that recur due to tumor ingrowth [30]. With respect to the esophagus, few previous studies report on the clinical and technical success of the placement of a second or third stent after dysfunction of the first or second, both in gastroduodenal and colorectal obstructions [16-22].…”

Improving stent efficiency by understanding stent-related adverse events

“…This heterogeneity poses substantial challenges for systematically and prospectively evaluating these features. Randomized controlled trial data are notably scarce [3].…”