Esophageal stenting for relief of dysphagia

Abstract

The majority of the patients with esophageal cancer present with dysphagia and over 50% are unresectable at presentation. Some may also develop a trachea-esophageal fistula preventing them from oral intake. Self-expanding esophageal stents are now the most commonly used modality to palliate these patients since these stents are easy to place with minimally invasive techniques and the relief in symptoms is almost immediate. Plastic coating on the stents can also seal fistulae. Compared to chemoradiation, since the relief in symptoms with stents is immediate, these stents are also being considered for locally advanced esophageal cancer as a bridge to surgery for those requiring neoadjuvant therapy. This approach is not universally accepted since stents can be associated with serious complications that may delay therapy. With the availability of expandable stents that can be removed, there has been a great interest in using stents as long-term dilators for treating benign refractory esophageal strictures. Results have been mixed and several studies have reported significant complications. Hence stents for benign esophageal strictures should be used in carefully selected patients in centers with expertise to manage stent-related complications. Newer developments in design are needed. Biodegradable stents that get metabolized by the body and eventually absorbed are available in other countries and it will be interesting as to how they perform especially in those who need temporary esophageal stenting.