Efficacy and safety of self-expanding metal stents in advanced esophageal cancer: a 12-year analysis in a referral center

Esophageal cancer is often diagnosed in advanced stages, leading to significant dysphagia and affecting patients' quality of life. This study aims to evaluate the efficacy and safety of self-expanding metallic stents (SEMS) for the palliative treatment of advanced esophageal cancer. This observational study was conducted in a tertiary cancer center, analyzing a prospectively maintained database where those undergoing SEMS placement between January 2009 and January 2021 were analyzed. Technical and clinical success rates, improvement in dysphagia and adverse events were analyzed. A total of 364 patients were included (291 men, mean age 60.8 years). The technical success was 100%, with 88% of patients showing improvement in dysphagia after stent placement. Adverse events occurred in 58% of cases, with stent-induced fistula (14%) and stent migration (9%) being the most common. There was no relationship between stent covering (partially versus fully covered) and adverse events (fistula P = 0.056; migration P = 0.264; in/overgrowth P = 0.825). Median overall survival was 207.2 days, with 1-month and 3-month survival rates of 82% and 66%, respectively. Placement of esophageal SEMS in patients with advanced esophageal tumors has high technical and clinical success rates. It immediately improves dysphagia in most patients. Stent-induced fistula and stent migration are the most common adverse events. Their occurrence is not influenced by previous chemo radiation or the type of stent covering. In most cases, they can be endoscopically managed.