Adverse events of self-expandable esophageal metallic stents in patients with long-term survival from advanced malignant disease

Medeiros, Vitor Sousa; Martins, Bruno Costa; Lenz, Luciano; Ribeiro, Maria Fernanda Muzetti; Paulo, Gustavo Andrade de; Lima, Marcelo Simas de; Safatle‐Ribeiro, Adriana Vaz; Kawaguti, Fábio S.; Pennacchi, Caterina; Geiger, Sebastian; Bastos, Victor R.; Ribeiro, Ulysses; Sallum, Rubens Antônio Aissar; Maluf‐Filho, Fauze

doi:10.1016/j.gie.2016.12.017

Cited by 20 publications

(9 citation statements)

References 21 publications

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“…However, the association between prior palliative therapy and stent-related adverse events remains controversial. Several studies have reported that prior chemotherapy and/or radiotherapy increase the risk of life-threatening adverse events after SEMS placement, whereas other studies have shown the risk of adverse events to be unaffected [29,34,[74][75][76][77][78][79][80][81][82]. Pneumonia, fistula formation, and stent-related pain may be increased in patients with prior therapy who receive stents [29,34,[80][81][82].…”

Section: Prior Palliative Therapymentioning

confidence: 99%

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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Main recommendations Malignant disease 1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass.Strong recommendation, high quality evidence. 2 ESGE recommends brachytherapy as a valid alternative, alone or in addition to stenting, in esophageal cancer patients with malignant dysphagia and expected longer life expectancy.Strong recommendation, high quality evidence. 3 ESGE recommends esophageal SEMS placement for sealing malignant tracheoesophageal or bronchoesophageal fistulas. Strong recommendation, low quality evidence. 4 ESGE does not recommend SEMS placement as a bridge to surgery or before preoperative chemoradiotherapy because it is associated with a high incidence of adverse events. Other options such as feeding tube placement are preferable. Strong recommendation, low quality evidence. Benign disease 5 ESGE recommends against the use of SEMSs as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and their cost. Strong recommendation, low quality evidence. 6 ESGE suggests consideration of temporary placement of self-expandable stents for refractory benign esophageal strictures. Weak recommendation, moderate quality evidence. 7 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures because of their very low risk of embedment and ease of removability. Weak recommendation, low quality evidence. 8 ESGE recommends the stent-in-stent technique to remove partially covered SEMSs that are embedded in the esophageal wall. Strong recommendation, low quality evidence. 9 ESGE recommends that temporary stent placement can be considered for the treatment of leaks, fistulas, and perforations. No specific type of stent can be recommended, and the duration of stenting should be individualized. Strong recommendation, low quality of evidence. 10 ESGE recommends considering placement of a fully covered large-diameter SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive bleeding. Strong recommendation, moderate quality evidence.

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Section: Prior Palliative Therapymentioning

confidence: 99%

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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“…Migration, occlusion, perforation, hemorrhage, and ulceration are the most widespread complications related to stents. Mortality rate stent application varies between 0.5% and 2% [ 18 , 19 ]. Complications can be categorized under intraoperative or postoperative complications in the early and late periods.…”

Section: Discussionmentioning

confidence: 99%

Stent Applications for Palliative Treatment in Advanced Stage Esophageal Cancers

Şentürk

Çakır

Yıldırım

et al. 2021

Gastroenterology Research and Practice

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Background and Aim. Endoscopic stenting is a generally safe and effective palliative treatment for esophageal malignancies. In this study, we aimed to present endoscopic stent applications, adverse events, and relative advantages of covered versus uncovered stents in our center. Methods. We examined cases of endoscopic stenting for palliative treatment of advanced stage esophageal cancers between January 2014 and July 2019. Age, gender, location of mass, adverse events, survival time, and stent type were evaluated. Outcomes of fully covered and uncovered self-expanding stents were compared with regard to adverse events, including stent migration and occlusion. Results. The mean age of the patients was 66.4 ± 1 , 52 were male, and 8 were female. Patients were followed up for a mean of 133 days. The most common complication due to stenting was migration. 13 patients developed adverse events. Migration was the most common adverse event, occurring in 8 (13%) patients. Although the migration rate of fully covered stents was higher than uncovered stents, there was no statistically significant difference ( p = 0.47 ). Stent occlusion was observed in 4 patients. In three cases, it was due to the tumor; an uncovered stent was placed again in these cases. Food-related occlusion developed in one patient. There was no statistical difference in terms of overall adverse event rate when comparing fully covered stents to uncovered stents ( p = 0.68 ). Conclusion. Endoscopic stenting is a viable palliative method with low morbidity and mortality in experienced centers. Though there are relative advantages with covered versus uncovered stents in individual cases, the overall adverse event rate is low and relatively similar.

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“…We thank Dr Eduardo Rodrigues-Pinto et al 1 for their interest in our article. 2 The fact that they have found similar results in their experience is reassuring.…”

Section: Responsementioning

confidence: 96%

Should performance status impact stent decision-making in patients with long-term survival from advanced esophageal cancer?

Rodrigues‐Pinto

Pereira

Baron

et al. 2017

Gastrointestinal Endoscopy

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We read with interest the article concerning adverse events (AEs) of self-expandable esophageal metallic stents (SEMSs) in patients with long-term survival from advanced esophageal cancer by Medeiros et al 1 in Gastrointestinal Endoscopy. AEs occurred in 63.5% of the 63 patients; however, they were not related to higher mortality rate, and 84.5% could be successfully managed endoscopically. Only performance status was a risk factor for AEs. The authors hypothesized that poor performance status could be associated with more aggressive biological behavior, which could explain a higher rate of AEs. However, patients who experienced AEs survived longer than did patients without AEs. We revisited our esophageal stent data from 2011 to 2014 and reached similar conclusions. 2 We included only patients whose stents remained in place for more than 6 months. Clinical improvement occurred in all patients (n Z 21), but 52.4% of patients experienced an AE, with a median stent patency of 236 days. Endoscopic management was feasible in every SEMS-related AE, with a clinical success rate of 100%. It is important to notice, however, that AEs recurred in 5 patients after successful endoscopic therapy. We are skeptical that poor performance status is a risk factor for AEs. It is notable that AEs were distributed evenly over time, with most of them occurring after 180 days. This would contradict more-aggressive biological behavior as the cause of a higher rate of AEs because such patients should theoretically have shorter survival and subsequently shorter stent dwell times. We believe that the seeming paradoxical increase in AEs with prolonged survival is related to the increase in stent dwell time. We believe that longer survival times and longer stent dwell times result in more AEs. Future studies should be performed to assess this hypothesis. DISCLOSURE Dr Baron is a consultant for Olympus and Boston Scientific. All other authors disclosed no financial relationships relevant to this publication.

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Adverse events of self-expandable esophageal metallic stents in patients with long-term survival from advanced malignant disease

Cited by 20 publications

References 21 publications

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Stent Applications for Palliative Treatment in Advanced Stage Esophageal Cancers

Should performance status impact stent decision-making in patients with long-term survival from advanced esophageal cancer?

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