Self-expandable metal stents are a valid option in long-term survivors of advanced esophageal cancer

Abstract

BACKGROUND: self-expandable metal stents are often used for the palliative treatment of dysphagia in patients with advanced esophageal cancer and an anticipated limited survival. Due to previous reports of a high rate of adverse event when used long-term, concerns have been raised with regard to the use of self-expandable metal stents in patients with a longer survival. AIM: assess the role of esophageal self-expandable metal stents in patients with advanced esophageal cancer that have survived longer than six months. METHODS: retrospective study of patients with advanced esophageal cancer with a self-expandable metal stent and a stent placement time greater than six months. RESULTS: forty-two patients were followed up for 298 days. There was a clinical improvement in all patients. However, 59% of patients experienced an adverse event. The median stent patency was 236 days. Endoscopic management was attempted in all self-expandable metal related adverse events, with a clinical success rate of 100%. However, the previously treated adverse event recurred in seven patients. Multivariate analysis showed that strictures that were traversable with an ultrathin gastroscope were associated with a higher risk of adverse events (p = 0.035). CONCLUSIONS: long-term esophageal stenting in patients with advanced esophageal cancer is associated with a high prevalence of adverse events without an impact on mortality; most cases can be managed endoscopically.