Expandable metal stents are used increasingly as a non-surgical alternative for the palliation of luminal gastrointestinal neoplasms, particularly esophageal cancer. Esophageal cancer is often diagnosed at an advanced stage, and stents can be useful for symptom palliation in patients with locally unresectable or advanced metastatic esophageal cancer, those with poor functional status who cannot tolerate surgery or chemoradiotherapy, or for those with locally recurrent disease after primary treatment. These patients generally have weight loss and dysphagia due to esophageal obstruction. Furthermore, cough and/or aspiration may be the result of a tracheoesophageal fistula, either as a complication of the tumor or its treatment.
Although less effective than when used for the treatment of distal esophageal obstruction, expandable metal stents can be placed successfully in patients with proximal or cervical esophageal malignant strictures .
Esophageal stents may provide palliation of dysphagia caused by extraesophageal malignancies that compress the esophagus extrinsically. However, symptom improvement is significantly less in this setting than in patients with intrinsic esophageal lesions . In addition, self-expandable stents are being used to treat benign esophageal disorders such as esophageal leaks, fistulas, and refractory strictures .
This topic will review the use of expandable stents in the treatment of esophageal obstruction from esophageal cancer and extrinsic esophageal compression from extraesophageal malignancies. A general overview of several methods of endoscopic palliation for esophageal cancer and the use of expandable stents in other portions of the gastrointestinal tract are discussed elsewhere. (See "Endoscopic palliation of esophageal cancer" and "Enteral stents for the palliation of malignant gastroduodenal obstruction" and "Enteral stents for the management of malignant colorectal obstruction" and "Endoscopic stenting for malignant pancreaticobiliary obstruction".)
TYPES OF STENTS
There are three types of expandable stents: metal, plastic, and biodegradable.