Use of expandable stents in the esophagus
- Todd H Baron, MD
Todd H Baron, MD
- Director of Advanced Therapeutic Endoscopy
- University of North Carolina, Chapel Hill
Expandable metal stents are now commonly used 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.
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- TYPES OF STENTS
- Self-expandable metal stents
- Self-expandable plastic stents
- Self-expandable biodegradable stents
- Comparison of expandable stents with other modalities for inoperable esophageal cancer
- - SEMS versus rigid plastic tubes
- - SEMS versus laser
- - SEMS versus brachytherapy
- Comparison of stents
- Stenting for patients undergoing neoadjuvant chemotherapy
- Stenting for esophageal cancer recurrence
- Stenting for extraesophageal compression
- Benign disease
- ADVERSE EVENTS
- Types of adverse events
- Esophagorespiratory fistulas
- Stent migration and occlusion
- Gastroesophageal reflux
- SAFETY OF MRI
- SUMMARY AND RECOMMENDATIONS