Outcome and complications of long-term self-expanding esophageal stenting

Abstract

Esophageal stenting with self-expanding plastic or covered metal stents is believed to be safe and effective. As data on the outcome of patients with long-term stenting are not available, this study was conducted to evaluate the safety and efficacy of long-term esophageal stenting. From 2002 to 2008, 70 patients with long-term esophageal stenting for various indications from a prospective database were included into further analysis. The median stent period was 297 (124-1980) days during a mean follow-up time of 55 ± 52.4 months. Overall complication rate was 30% with a primary success rate of 97.2%. The stent-related total reintervention rate was 17.1%. There were no correlations between stent characteristics and the risk of complication or migration. No stent-related death was observed. Our data provide evidence that long-period esophageal stenting is safe and effective for various indications.

Esophageal stents: Beyond the simple stricture

“…Stent migration rates in the mid-esophagus are in the region of 5%, while migration rates of stents placed with the lower end at the stomach average 15% to 20% 1 with some designs performing markedly worse than others. [19][20][21] The risk of migration is increased with subsequent chemo-or radiotherapy.…”

Treatment of complications caused by metallic stent placement in esophageal cancer

“…[1,3,8,18] In our study, a re-intervention (new stent placement, removal of the stent, stent dilation, or removal of food residues) became necessary in 72 (26.9%) patients. Considering that the mortality rate was low (1.5%) and the mean survival rate was approximately six months in our study, we may conclude that esophageal stent provides significant palliation.…”

“…[7,8] However, complications are still observed in the early (within the first week after stenting) and late periods (after one week) due to the use of metallic stents. Most common major complications in the early period are migration, hemorrhage and perforation, and are reported at an average rate of 6 to 7%.…”

Gastrointestinal stenting: Current status and imaging features

“…Late morbidity can also be due to technical problems (stent occlusion secondary to tissue in-and/or overgrowth in 11.3%, stent migration in 7%) or related to patients (gastroesophageal reflux in 3.7%, recurrent dysphagia in 8.2%, esophageal fistula in 2.8%, hemorrhage in 3.9%, esophageal perforation in 0.8% and thirty day mortality in 7.4%) [51,52]. Esophageal stent migration is more common when stents are placed near the gastroesophageal junction [53]. The actual mechanism of hemorrhage after placement of esophageal stent is controversial (pressure necrosis of the tumor and of the esophageal wall is one of these).…”