Skip to main content

Advertisement

SpringerLink
Log in

Esophageal Stents in Malignant and Benign Disorders

  • Esophagus (L Gerson, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Endoscopic stent placement is an effective palliative treatment for malignant dysphagia and fistula, leading to rapid symptom relief. However, recurrent dysphagia and other stent-related complications are common, for which reason continuously new design modifications are implemented. Although some of these changes facilitate stent placement, complications remain and occur at similar rates. Recently, stents have also been used in benign esophageal disorders. Covered stents have the ability to effectively seal esophageal perforations and leaks, reducing the need for invasive surgery. This benefit does not pertain to patients with refractory benign esophageal strictures, in whom stents have limited long-term effect and are associated with a high complication rate. The initial results of fully covered metal stents in refractory esophageal variceal bleeding are encouraging, but their definite role remains to be further elucidated. This review provides an overview of indications, techniques, and management of complications of stents in malignant and benign esophageal disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Hill JL, Norberg HP, Smith MD, et al. Clinical technique and success of the esophageal stent to prevent corrosive strictures. J Pediatr Surg. 1976;11:443–50.

    Article  PubMed  CAS  Google Scholar 

  2. Diamantis G, Scarpa M, Bocus P, et al. Quality of life in patients with esophageal stenting for the palliation of malignant dysphagia. World J Gastroenterol. 2011;17:144–50.

    Article  PubMed  Google Scholar 

  3. Sharma P, Kozarek R, Practice Parameters Committee of American College of G. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol. 2010;105:258–73. quiz 274.

    Article  PubMed  Google Scholar 

  4. Spaander MCW, Didden P, Haringsma J, et al. M1958 twelve years experience with self expandable stents for malignant esophageal strictures in 592 patients; has the outcome improved over the years? Gastroenterology. 2009;136:A–455.

    Article  Google Scholar 

  5. Homs MY, Steyerberg EW, Eijkenboom WM, et al. Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet. 2004;364:1497–504.

    Article  PubMed  Google Scholar 

  6. Homs MY, Steyerberg EW, Kuipers EJ, et al. Causes and treatment of recurrent dysphagia after self-expanding metal stent placement for palliation of esophageal carcinoma. Endoscopy. 2004;36:880–6.

    Article  PubMed  CAS  Google Scholar 

  7. Verschuur EM, Kuipers EJ, Siersema PD. Esophageal stents for malignant strictures close to the upper esophageal sphincter. Gastrointest Endosc. 2007;66:1082–90.

    Article  PubMed  Google Scholar 

  8. Sreedharan A, Harris K, Crellin A, et al. Interventions for dysphagia in oesophageal cancer. Cochrane Database Syst Rev. 2009;CD005048.

  9. Vakil N, Morris AI, Marcon N, et al. A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction. Am J Gastroenterol. 2001;96:1791–6.

    Article  PubMed  CAS  Google Scholar 

  10. Uitdehaag MJ, van Hooft JE, Verschuur EM, et al. A fully-covered stent (Alimaxx-E) for the palliation of malignant dysphagia: a prospective follow-up study. Gastrointest Endosc. 2009;70:1082–9.

    Article  PubMed  Google Scholar 

  11. Bethge N, Vakil N. A prospective trial of a new self-expanding plastic stent for malignant esophageal obstruction. Am J Gastroenterol. 2001;96:1350–4.

    Article  PubMed  CAS  Google Scholar 

  12. Siersema PD, Hop WC, van Blankenstein M, et al. A comparison of 3 types of covered metal stents for the palliation of patients with dysphagia caused by esophagogastric carcinoma: a prospective, randomized study. Gastrointest Endosc. 2001;54:145–53.

    Article  PubMed  CAS  Google Scholar 

  13. Sabharwal T, Hamady MS, Chui S, et al. A randomised prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma. Gut. 2003;52:922–6.

    Article  PubMed  CAS  Google Scholar 

  14. Conio M, Repici A, Battaglia G, et al. A randomized prospective comparison of self-expandable plastic stents and partially covered self-expandable metal stents in the palliation of malignant esophageal dysphagia. Am J Gastroenterol. 2007;102:2667–77.

    Article  PubMed  Google Scholar 

  15. Verschuur EM, Repici A, Kuipers EJ, et al. New design esophageal stents for the palliation of dysphagia from esophageal or gastric cardia cancer: a randomized trial. Am J Gastroenterol. 2008;103:304–12.

    Article  PubMed  Google Scholar 

  16. van Heel NC, Haringsma J, Boot H, et al. Comparison of 2 expandable stents for malignant esophageal disease: a randomized controlled trial. Gastrointest Endosc. 2012;76:52–8.

    Article  PubMed  Google Scholar 

  17. Conigliaro R, Battaglia G, Repici A, et al. Polyflex stents for malignant oesophageal and oesophagogastric stricture: a prospective, multicentric study. Eur J Gastroenterol Hepatol. 2007;19:195–203.

    Article  PubMed  Google Scholar 

  18. Szegedi L, Gal I, Kosa I, et al. Palliative treatment of esophageal carcinoma with self-expanding plastic stents: a report on 69 cases. Eur J Gastroenterol Hepatol. 2006;18:1197–201.

    Article  PubMed  Google Scholar 

  19. van Boeckel PG, Repici A, Vleggaar FP, et al. A new metal stent with a controlled-release system for palliation of malignant dysphagia: a prospective, multicenter study. Gastrointest Endosc. 2010;71:455–60.

    Article  PubMed  Google Scholar 

  20. Uitdehaag MJ, Siersema PD, Spaander MC, et al. A new fully covered stent with antimigration properties for the palliation of malignant dysphagia: a prospective cohort study. Gastrointest Endosc. 2010;71:600–5.

    Article  PubMed  Google Scholar 

  21. Talreja JP, Eloubeidi MA, Sauer BG, et al. Fully covered removable nitinol self-expandable metal stents (SEMS) in malignant strictures of the esophagus: a multicenter analysis. Surg Endosc. 2012;26:1664–9.

    Article  PubMed  Google Scholar 

  22. Choi SJ, Kim JH, Choi JW, et al. Fully covered, retrievable self-expanding metal stents (Niti-S) in palliation of malignant dysphagia: long-term results of a prospective study. Scand J Gastroenterol. 2011;46:875–80.

    Article  PubMed  Google Scholar 

  23. Kim ES, Jeon SW, Park SY, et al. Comparison of double-layered and covered Niti-S stents for palliation of malignant dysphagia. J Gastroenterol Hepatol. 2009;24:114–9.

    Article  PubMed  Google Scholar 

  24. Verschuur EM, Homs MY, Steyerberg EW, et al. A new esophageal stent design (Niti-S stent) for the prevention of migration: a prospective study in 42 patients. Gastrointest Endosc. 2006;63:134–40.

    Article  PubMed  Google Scholar 

  25. Hirdes MM, Siersema PD, Vleggaar FP. A new fully covered metal stent for the treatment of benign and malignant dysphagia: a prospective follow-up study. Gastrointest Endosc. 2012;75:712–8.

    Article  PubMed  Google Scholar 

  26. Bethge N, Sommer A, Vakil N. Treatment of esophageal fistulas with a new polyurethane-covered, self-expanding mesh stent: a prospective study. Am J Gastroenterol. 1995;90:2143–6.

    PubMed  CAS  Google Scholar 

  27. Do YS, Song HY, Lee BH, et al. Esophagorespiratory fistula associated with esophageal cancer: treatment with a Gianturco stent tube. Radiology. 1993;187:673–7.

    PubMed  CAS  Google Scholar 

  28. Dumonceau JM, Cremer M, Lalmand B, et al. Esophageal fistula sealing: choice of stent, practical management, and cost. Gastrointest Endosc. 1999;49:70–8.

    Article  PubMed  CAS  Google Scholar 

  29. Kozarek RA, Raltz S, Brugge WR, et al. Prospective multicenter trial of esophageal Z-stent placement for malignant dysphagia and tracheoesophageal fistula. Gastrointest Endosc. 1996;44:562–7.

    Article  PubMed  CAS  Google Scholar 

  30. May A, Ell C. Palliative treatment of malignant esophagorespiratory fistulas with Gianturco-Z stents. A prospective clinical trial and review of the literature on covered metal stents. Am J Gastroenterol. 1998;93:532–5.

    PubMed  CAS  Google Scholar 

  31. Morgan RA, Ellul JP, Denton ER, et al. Malignant esophageal fistulas and perforations: management with plastic-covered metallic endoprostheses. Radiology. 1997;204:527–32.

    PubMed  CAS  Google Scholar 

  32. Sarper A, Oz N, Cihangir C, et al. The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas. Eur J Cardiothorac Surg. 2003;23:794–8.

    Article  PubMed  Google Scholar 

  33. Shin JH, Song HY, Ko GY, et al. Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology. 2004;232:252–9.

    Article  PubMed  Google Scholar 

  34. Homs MY, Hansen BE, van Blankenstein M, et al. Prior radiation and/or chemotherapy has no effect on the outcome of metal stent placement for oesophagogastric carcinoma. Eur J Gastroenterol Hepatol. 2004;16:163–70.

    Article  PubMed  Google Scholar 

  35. Lecleire S, Di Fiore F, Ben-Soussan E, et al. Prior chemoradiotherapy is associated with a higher life-threatening complication rate after palliative insertion of metal stents in patients with oesophageal cancer. Aliment Pharmacol Ther. 2006;23:1693–702.

    Article  PubMed  CAS  Google Scholar 

  36. Didden P, Spaander MC, Kuipers EJ, et al. Safety of stent placement in recurrent or persistent esophageal cancer after definitive chemoradiotherapy: a case series. Gastrointest Endosc. 2012;76:426–30.

    Article  PubMed  Google Scholar 

  37. Bick BL, Wong Kee Song LM, Buttar NS, et al. Stent-associated esophagorespiratory fistulas: incidence and risk factors. Gastrointest Endosc. 2013;77:181–9.

  38. Hirdes MM, van Hooft JE, Wijrdeman HK, et al. Combination of biodegradable stent placement and single-dose brachytherapy is associated with an unacceptably high complication rate in the treatment of dysphagia from esophageal cancer. Gastrointest Endosc. 2012;76:267–74.

    Article  PubMed  Google Scholar 

  39. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84.

    Article  PubMed  Google Scholar 

  40. Adler DG, Fang J, Wong R, et al. Placement of Polyflex stents in patients with locally advanced esophageal cancer is safe and improves dysphagia during neoadjuvant therapy. Gastrointest Endosc. 2009;70:614–9.

    Article  PubMed  Google Scholar 

  41. Langer FB, Schoppmann SF, Prager G, et al. Temporary placement of self-expanding oesophageal stents as bridging for neo-adjuvant therapy. Ann Surg Oncol. 2010;17:470–5.

    Article  PubMed  Google Scholar 

  42. Pellen MG, Sabri S, Razack A, et al. Safety and efficacy of self-expanding removable metal esophageal stents during neoadjuvant chemotherapy for resectable esophageal cancer. Dis Esophagus. 2012;25:48–53.

    Article  PubMed  CAS  Google Scholar 

  43. Siddiqui AA, Glynn C, Loren D, et al. Self-expanding plastic esophageal stents versus jejunostomy tubes for the maintenance of nutrition during neoadjuvant chemoradiation therapy in patients with esophageal cancer: a retrospective study. Dis Esophagus. 2009;22:216–22.

    Article  PubMed  CAS  Google Scholar 

  44. Siddiqui AA, Sarkar A, Beltz S, et al. Placement of fully covered self-expandable metal stents in patients with locally advanced esophageal cancer before neoadjuvant therapy. Gastrointest Endosc. 2012;76:44–51.

    Article  PubMed  Google Scholar 

  45. Homann N, Noftz MR, Klingenberg-Noftz RD, et al. Delayed complications after placement of self-expanding stents in malignant esophageal obstruction: treatment strategies and survival rate. Dig Dis Sci. 2008;53:334–40.

    Article  PubMed  Google Scholar 

  46. Didden P, Kuipers EJ, Bruno MJ, et al. Endoscopic removal of a broken self-expandable metal stent using the stent-in-stent technique. Endoscopy. 2012;44(Suppl 2 UCTN):E232.

    PubMed  Google Scholar 

  47. • Hirdes MM, Siersema PD, Houben MH, et al. Stent-in-stent technique for removal of embedded esophageal self-expanding metal stents. Am J Gastroenterol. 2011;106:286–93. This study demonstrates that the stent-in-stent technique is an effective and safe new removal technique for partially covered SEMS embedded in the esophageal wall.

    Article  PubMed  CAS  Google Scholar 

  48. Verschuur EM, Steyerberg EW, Kuipers EJ, et al. Effect of stent size on complications and recurrent dysphagia in patients with esophageal or gastric cardia cancer. Gastrointest Endosc. 2007;65:592–601.

    Article  PubMed  Google Scholar 

  49. Siersema PD. Stenting for benign esophageal strictures. Endoscopy. 2009;41:363–73.

    Article  PubMed  CAS  Google Scholar 

  50. Pereira-Lima JC, Ramires RP, Zamin Jr I, et al. Endoscopic dilation of benign esophageal strictures: report on 1043 procedures. Am J Gastroenterol. 1999;94:1497–501.

    Article  PubMed  CAS  Google Scholar 

  51. Lew RJ, Kochman ML. A review of endoscopic methods of esophageal dilation. J Clin Gastroenterol. 2002;35:117–26.

    Article  PubMed  Google Scholar 

  52. Raymondi R, Pereira-Lima JC, Valves A, et al. Endoscopic dilation of benign esophageal strictures without fluoroscopy: experience of 2750 procedures. Hepatogastroenterology. 2008;55:1342–8.

    PubMed  Google Scholar 

  53. Hordijk ML, van Hooft JE, Hansen BE, et al. A randomized comparison of electrocautery incision with Savary bougienage for relief of anastomotic gastroesophageal strictures. Gastrointest Endosc. 2009;70:849–55.

    Article  PubMed  Google Scholar 

  54. • Thomas T, Abrams KR, Subramanian V, et al. Esophageal stents for benign refractory strictures: a meta-analysis. Endoscopy. 2011;43:386–93. This meta-analysis provides an overview of all available studies evaluating the efficacy of SEMS and SEPS in the treatment of benign refractory esophageal strictures. Overall, 46.2 % of patients had dysphagia improvement at an average follow-up of 74 weeks. Migration rate was 26.4 %.

    Article  PubMed  CAS  Google Scholar 

  55. Cwikiel W, Willen R, Stridbeck H, et al. Self-expanding stent in the treatment of benign esophageal strictures: experimental study in pigs and presentation of clinical cases. Radiology. 1993;187:667–71.

    PubMed  CAS  Google Scholar 

  56. Tan BS, Kennedy C, Morgan R, et al. Using uncovered metallic endoprostheses to treat recurrent benign esophageal strictures. AJR Am J Roentgenol. 1997;169:1281–4.

    Article  PubMed  CAS  Google Scholar 

  57. van Heel NC, Haringsma J, Wijnhoven BP, et al. Endoscopic removal of self-expandable metal stents from the esophagus (with video). Gastrointest Endosc. 2011;74:44–50.

    Article  PubMed  Google Scholar 

  58. van Halsema EE, Wong Kee Song LM, Baron TH, et al. Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases. Gastrointest Endosc. 2013;77:18–28.

    Article  PubMed  Google Scholar 

  59. Bakken JC, Wong Kee Song LM, de Groen PC, et al. Use of a fully covered self-expandable metal stent for the treatment of benign esophageal diseases. Gastrointest Endosc. 2010;72:712–20.

    Article  PubMed  Google Scholar 

  60. Eloubeidi MA, Talreja JP, Lopes TL, et al. Success and complications associated with placement of fully covered removable self-expandable metal stents for benign esophageal diseases (with videos). Gastrointest Endosc. 2011;73:673–81.

    Article  PubMed  Google Scholar 

  61. Lyons CD, Kim MP, Blackmon SH. A novel fixation procedure to eliminate covered self-expanding metal stent migration. Ann Thorac Surg. 2012;94:1748–50.

    Article  PubMed  Google Scholar 

  62. Rieder E, Dunst CM, Martinec DV, et al. Endoscopic suture fixation of gastrointestinal stents: proof of biomechanical principles and early clinical experience. Endoscopy. 2012;44:1121–6.

    Article  PubMed  CAS  Google Scholar 

  63. Toshniwal J, Zabielski M, Fry LC, et al. Combination of the “bear claw” (over-the-scope-clip system) and fully covered stent for the treatment of post-operative anastomotic leak. Endoscopy. 2012;44(Suppl 2 UCTN):E288–9.

    PubMed  Google Scholar 

  64. Vanbiervliet G, Filippi J, Karimdjee BS, et al. The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study. Surg Endosc. 2012;26:53–9.

    Article  PubMed  Google Scholar 

  65. van Heel NC, Haringsma J, Spaander MC, et al. Short-term esophageal stenting in the management of benign perforations. Am J Gastroenterol. 2010;105:1515–20.

    Article  PubMed  Google Scholar 

  66. Dua KS, Vleggaar FP, Santharam R, et al. Removable self-expanding plastic esophageal stent as a continuous, non-permanent dilator in treating refractory benign esophageal strictures: a prospective two-center study. Am J Gastroenterol. 2008;103:2988–94.

    Article  PubMed  Google Scholar 

  67. Evrard S, Le Moine O, Lazaraki G, et al. Self-expanding plastic stents for benign esophageal lesions. Gastrointest Endosc. 2004;60:894–900.

    Article  PubMed  Google Scholar 

  68. Holm AN, de la Mora Levy JG, Gostout CJ, et al. Self-expanding plastic stents in treatment of benign esophageal conditions. Gastrointest Endosc. 2008;67:20–5.

    Article  PubMed  Google Scholar 

  69. Karbowski M, Schembre D, Kozarek R, et al. Polyflex self-expanding, removable plastic stents: assessment of treatment efficacy and safety in a variety of benign and malignant conditions of the esophagus. Surg Endosc. 2008;22:1326–33.

    Article  PubMed  CAS  Google Scholar 

  70. Pennathur A, Chang AC, McGrath KM, et al. Polyflex expandable stents in the treatment of esophageal disease: initial experience. Ann Thorac Surg. 2008;85:1968–72. discussion 1973.

    Article  PubMed  Google Scholar 

  71. Repici A, Conio M, De Angelis C, et al. Temporary placement of an expandable polyester silicone-covered stent for treatment of refractory benign esophageal strictures. Gastrointest Endosc. 2004;60:513–9.

    Article  PubMed  Google Scholar 

  72. Repici A, Vleggaar FP, Hassan C, et al. Efficacy and safety of biodegradable stents for refractory benign esophageal strictures: the BEST (Biodegradable Esophageal Stent) study. Gastrointest Endosc. 2010;72:927–34.

    Article  PubMed  Google Scholar 

  73. Saito Y, Tanaka T, Andoh A, et al. Usefulness of biodegradable stents constructed of poly-l-lactic acid monofilaments in patients with benign esophageal stenosis. World J Gastroenterol. 2007;13:3977–80.

    PubMed  Google Scholar 

  74. Hirdes MM, Siersema PD, van Boeckel PG, et al. Single and sequential biodegradable stent placement for refractory benign esophageal strictures: a prospective follow-up study. Endoscopy. 2012;44:649–54.

    Article  PubMed  CAS  Google Scholar 

  75. Song TJ, Lee SS, Yun SC, et al. Paclitaxel-eluting covered metal stents versus covered metal stents for distal malignant biliary obstruction: a prospective comparative pilot study. Gastrointest Endosc. 2011;73:727–33.

    Article  PubMed  Google Scholar 

  76. Jeon SR, Eun SH, Shim CS, et al. Effect of drug-eluting metal stents in benign esophageal stricture: an in vivo animal study. Endoscopy. 2009;41:449–56.

    Article  PubMed  CAS  Google Scholar 

  77. Attar S, Hankins JR, Suter CM, et al. Esophageal perforation: a therapeutic challenge. Ann Thorac Surg. 1990;50:45–9. discussion 50–1.

    Article  PubMed  CAS  Google Scholar 

  78. Brinster CJ, Singhal S, Lee L, et al. Evolving options in the management of esophageal perforation. Ann Thorac Surg. 2004;77:1475–83.

    Article  PubMed  Google Scholar 

  79. • van Boeckel PG, Sijbring A, Vleggaar FP, et al. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther. 2011;33:1292–301. This recent systematic review is the largest pooled analysis of all available studies evaluating the use of SEMS and SEPS in esophageal perforations or anastomotic leaks. Overall clinical success was achieved in 85 % of patients without any difference in outcome between stent designs and stent-related complications occurred in 34 %.

    Article  PubMed  Google Scholar 

  80. Dechene A, El Fouly AH, Bechmann LP, et al. Acute management of refractory variceal bleeding in liver cirrhosis by self-expanding metal stents. Digestion. 2012;85:185–91.

    Article  PubMed  CAS  Google Scholar 

  81. Hubmann R, Bodlaj G, Czompo M, et al. The use of self-expanding metal stents to treat acute esophageal variceal bleeding. Endoscopy. 2006;38:896–901.

    Article  PubMed  CAS  Google Scholar 

  82. Wright G, Lewis H, Hogan B, et al. A self-expanding metal stent for complicated variceal hemorrhage: experience at a single center. Gastrointest Endosc. 2010;71:71–8.

    Article  PubMed  Google Scholar 

  83. Zehetner J, Shamiyeh A, Wayand W, et al. Results of a new method to stop acute bleeding from esophageal varices: implantation of a self-expanding stent. Surg Endosc. 2008;22:2149–52.

    Article  PubMed  CAS  Google Scholar 

  84. Holster IL, Kuipers EJ, van Buuren HR, et al. Self-expandable metal stents as definitive treatment for esophageal variceal bleeding. Endoscopy. 2013; in press.

Download references

Conflict of Interest

P. Didden declares that he has no conflict of interest.

M. C. W. Spaander declares that she has no conflict of interest.

M. J. Bruno declares that he has no conflict of interest.

E. J. Kuipers declares that he has no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, ‘s Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands

    P. Didden, M. C. W. Spaander, M. J. Bruno & E. J. Kuipers

Authors
  1. P. Didden
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. C. W. Spaander
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. J. Bruno
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. J. Kuipers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. C. W. Spaander.

Additional information

This article is part of the Topical Collection on Esophagus

Rights and permissions

Reprints and permissions

About this article

Cite this article

Didden, P., Spaander, M.C.W., Bruno, M.J. et al. Esophageal Stents in Malignant and Benign Disorders. Curr Gastroenterol Rep 15, 319 (2013). https://doi.org/10.1007/s11894-013-0319-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-013-0319-3

Keywords

Search

Navigation