Temporary Placement of Self-Expanding Oesophageal Stents as Bridging for Neo-Adjuvant Therapy

Abstract

Placement of self-expanding stents is highly effective for instant dysphagia relief, enabling adequate oral nutrition during neo-adjuvant therapy, but is limited by a high re-intervention rate.

Self-Expanding Covered Metallic Stent as a Bridge to Surgery in Esophageal Cancer: Impact on Oncologic Outcomes

“…Despite this, some studies have examined the role of stents as a bridge to surgery and reported that their insertion can be performed with safe early results, but none of these studies reported data on oncologic outcomes (Table 4). [7][8][9][10][11][12][13][14][15][16] The current study is the first to show that SEMS placement negatively impacts oncologic outcomes, with significantly lower R0 resection rates, time to recurrence, and OS, and significantly higher rates of locoregional recurrence. The results remained significant after excluding SEMS-related esophageal perforations, highlighting that the complications of stent placement are not solely responsible for these poor outcomes.…”

“…6 The indications for SEMS use have expanded to include relief from dysphagia in patients with resectable EC and for those who require neoadjuvant treatment before resection. [7][8][9][10][11][12][13][14][15][16] Self-expanding covered metallic stent insertion can immediately relieve dysphagia and allow for the maintenance of oral nutrition, 17 and a series of articles highlight that their use is associated with safe early results. [7][8][9][10][11][12][13][14][15][16] However, the impact of SEMS insertion on oncologic outcomes in the neoadjuvant setting is unknown.…”

Enteral stents

“…31 Covered esophageal stents may be temporarily placed to relieve dysphagia, whereas patients undergo neoadjuvant therapy, thereby acting as a bridge to surgery. [32][33][34][35] Both plastic [32][33][34] and metal stents 35 have been used for this indication, which is yet to be approved by the U.S. Food and Drug Administration. After successful stent placement, improvement in dysphagia scores and nutritional status was reported in almost all patients.…”

“…Stent migration is a concern, particularly after initiation of neoadjuvant therapy, and has been reported in 24% to 46% of patients. [32][33][34][35] Elective removal of the stent has been attempted to reduce the migration risk. 36 …”

“…25,71,72 It has been suggested that smaller diameter stents should be chosen for upper esophageal tumors to avoid excessive compressive forces, which can lead to unpleasant symptoms and potentially cause airway compression or pressure necrosis with fistula formation. 35,73 One case series suggests stents can be successfully placed for tumors within 1 cm of the upper esophageal sphincter, but the authors recommended avoiding large-caliber stents in this region. 15 The overall death rate from palliative stenting of the esophagus has been estimated at 0.5% to 3.3% based on retrospective surveys and reports including both SEMSs and rigid plastic stents.…”