Delayed complications after placement of self-expanding stents in malignant esophageal obstruction: treatment strategies and survival rate

Dig Dis Sci. 2008 Feb;53(2):334-40. doi: 10.1007/s10620-007-9862-9. Epub 2007 Jun 28.


Purpose: Placement of self-expanding metal stents is regarded as a safe and effective treatment in patients with incurable malignant esophagogastric obstruction. However, proceeding and possible benefit of re-interventions in patients with recurrent dysphagia due to delayed complications (>4 weeks after stent insertion) is unclear.

Patients and methods: In 133 patients with malignant stricture of the esophagus or the esophagogastric junction 164 expandable metal stents were placed. About 89 patients were followed up until death. All tumor- or stent-related complications and consequent re-interventions were recorded.

Results: The overall incidence of delayed complications was 53.4% (71 of 133 pts.), with 34 patients (25.6%) experiencing more than one complication. Recurrent dysphagia due to tumor ingrowth (22%) or overgrowth (15%), bolus obstruction (21%), stent migration (9%), and development of esophagorespiratory fistula (9%) was successfully treated by dilatation (24%), placement of a second/third stent (27%), laser therapy (16%), and/or placement of a feeding tube (PEG, 19%). The median survival of patients with endoscopic therapy was significantly longer (222 +/- 26 days) compared to patients without re-intervention (86 +/- 14 days, P < 0.0001).

Conclusions: Delayed complications after metal stent placement for malignant esophageal stricture are common, but can be treated successfully by endoscopic re-intervention in most cases. Regular interventional therapy may also improve survival.

MeSH terms

  • Aged
  • Deglutition Disorders / etiology
  • Endoscopy
  • Esophageal Neoplasms / complications*
  • Esophageal Stenosis / etiology
  • Esophageal Stenosis / therapy*
  • Esophagoscopy
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Stents*
  • Time Factors