Clinical outcomes following self-expanding metal stent placement for esophageal salvage

Abstract

Objectives: To assess the efficacy of self-expanding metal stents (SEMS) for esophageal salvage in patients who would otherwise require esophageal/conduit resection.

Methods: We performed a retrospective chart review of patients who had SEMS placed from January 2010 to December 2015. Patient demographics, esophageal stent characteristics, and outcomes were assessed in our patient cohort.

Results: Our study included a total of 83 patients. A total of 148 SEMS were placed, with 121 partially covered SEMS (pcSEMS) and 27 fully covered SEMS (cSEMS). A stent was placed more than once in 42.2% of the patients. Median duration of stent placement was 23 days. Indications for SEMS placement included esophageal leak after esophageal resection (45.8%), spontaneous esophageal perforation (22.9%), iatrogenic esophageal perforation (20.5%), and esophageal obstruction (9.6%). Complications from SEMS placement included 6 stent migrations and 1 esophageal perforation. Of the 6 stents that migrated, 2 were pcSEMS and 4 were cSEMS. In a patient who underwent stent placement for a stricture refractory to dilation, a perforation at the distal end was discovered 2 days after stent removal. The perforation healed after the second SEMS placement. Ultimately, 15 patients (18.1%) had to undergo a subsequent esophagectomy or takedown of their conduit with an overall 81.9% salvage of native esophagus or conduits.

Conclusions: Our study demonstrates the successful use of SEMS in patients with anastomotic leaks, perforations, and recalcitrant strictures.

Keywords: algorithm; esophageal stent; esophageal/conduit salvage; stent complications; techniques to anchor an esophageal stent.