Placement of fully covered self-expandable metal stents in patients with locally advanced esophageal cancer before neoadjuvant therapy

Management of inoperable malignant oesophageal strictures with fully covered WallFlex® stent: A multicentre prospective study

“…Similarly to previous reports for other stents in malignant strictures [9][10][11][12][13][14][15][16][17][18][19][20], stent placement in our cohort was safe and easy in almost all cases (98.8%), with only a minority of patients (18.2%) requiring pre-stent placement dilation. The fully covered WallFlex ® stent provided a good relief of malignant dysphagia, reducing the score from a median of 3 to a median of 1 (P < 0.001) both at 14 days and 4 weeks after stent placement, in line with previous studies.…”

“…A fact worth mentioning is that most of the stent migrations registered in our study (7 out of 10) occurred in patients with strictures located across the gastroesophageal junction, a location predisposing to stent migration, as data from the literature suggest [12,14,[20][21][22][23][24]. These favourable migration rates are likely the result of the new design of the stent, i.e., internal covering and a doublefunnel shape that stabilizes it in the stricture [7][8][9]24]. As expected from the fully covered stent design, we did not observe any case of tissue ingrowth [13,20], whilst our rate of tissue overgrowth is comparable to the rates reported with fully covered SEMS or fully covered self expandable plastic stents, which range between 0% and 38% [12][13][14]18,[22][23][24], and to previous experiences with the WallFlex ® stent which ranged from 0% to 19% [7][8][9].…”

“…Various types of self-expandable metal stents (SEMS), either fully covered or partially covered have been used for the palliation of malignant dysphagia [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Dysphagia relief has been reported in 80-100% of patients in most of these studies.…”

“…Fully covered SEMS have been designed to overcome such shortcomings with the assumption that the complete covering would greatly reduce tissue ingrowth and, consequently, reduce recurrent dysphagia (7-10). However, a well-known and predictable drawback of the fully covered design has been an increase in the rate of migration, ranging from 20% to 39% in most studies [8,9,13,17]. Lower rates of migration, in the order of 7-12%, have been reported with some new fully covered SEMS [7,12,21,22].…”

Optimization of Patients for Esophageal Cancer Surgery

“…Several recent trials have demonstrated their use in the near obstructed patient destined for neoadjuvant chemoradiotherapy [ 57 -59 ]. In addition to providing nutrition, stenting palliated obstructive symptoms leading to an improved quality of life [ 60 ]. The choice of stent is very important.…”