Ten-year experience of esophageal self-expanding metal stent insertion at a single institution

Abstract

Palliation of malignant dysphagia can be achieved using self-expanding metal stents (SEMS). This study was conceived to confirm that the insertion of SEMS improved patient symptoms without serious complications and to allow comparison with recent national data. Retrospective case note review of all patients receiving SEMS over a 10-year period between March 1999 and February 2009 was used in this study. There were 138 consecutive patients (50 female), median age of 75 (range 46-90) years, 122 (88.5%) had primary malignant disease of the esophagus or gastroesophageal junction. In total, 250 endoscopic examinations were carried out, with 200 interventional procedures, including the insertion of 156 SEMS. Before stenting, 74.2% of patients had a dysphagia score of 2-3. Following stent insertion, dysphagia scores improved to 0-1 in 90.3% of patients (P < 0.0001, Wilcoxon signed ranks). No complications were encountered in 61 (44%) patients. Chest pain was the most frequent difficulty, encountered in 50 (36%) patients. Tumor overgrowth occurred in 17 (12.3%) patients and food bolus obstruction was seen in 7% of patients. There were no esophageal perforations attributable to SEMS insertion. Overall 30-day mortality for those with esophago-gastric malignancy was 11.6% (16 patients), although the SEMS-related mortality was 2.2% (3 patients). Median survival from SEMS insertion was 3 (IQR 1.5-7) months. Patients requiring re-intervention for tumor overgrowth had a significantly longer median survival of 9.2 months (P= 0.001, log rank). SEMS were well tolerated with overall mortality and complication rates comparable to national data. For the longer survivors, re-intervention for recurrent dysphagia was not unusual.

Clinical outcomes of esophageal stents in patients with malignant esophageal obstruction according to palliative additional treatment

“…Previous studies have reported that the occurrence of adverse events in SEMS insertion was 36-50%. 11,12 Adverse events occurred in 22.9% of patients in the present study and developed less frequently than was found in other studies. Most of the adverse events were not lethal and more than 70% of them were managed with an additional endoscopic procedure.…”

Epidemiology, Diagnosis, and Management of Esophageal Adenocarcinoma

“…Covered self-expandable metal stents are often used for this indication, and their use is associated with marked improvement in dysphagia symptoms. 160, 161 However, this therapy has not been shown to increase survival times, and patients and clinicians must be familiar with the potential side effects of stent placement. One common side effect is stent migration, which occurs in up to 15% of patients and can require surgery for removal.…”

Clinical Outcomes of Upper Gastrointestinal Stents and Review of Current Literature

“…In the late term after stenting, food bolus impaction is reported to occur for 7% in the literature. 46 We encountered food bolus impaction in one of our patients (1.4%) who was using dentures because of chewing disfunction and dysphagia in 6 patients (8.7%) caused by tumor overgrowth. These rates are about 12.3% in the literature.…”