S4463 Holding Back Malignancy-Related Hemorrhage With Esophageal Stenting

Introduction: Self-expanding metal stents are commonly placed as palliative treatment in patients with esophageal malignancy to maintain luminal patency. Studies suggest endoscopic stent placement in this scenario can reduce the risk of developing esophageal bleeds. While the use of self-expanding stents to control refractory variceal bleeds has been described, available studies have not investigated the efficacy of stent placement to achieve hemostasis in active esophageal bleeds caused by malignancy. This case describes the application of esophageal stenting as salvage therapy for active malignancy-related bleeding. Case Description/Methods: A 64-year-old man with a prior history of stroke, Parkinson’s disease, type two diabetes, gastroesophageal reflux disease, tobacco use, presenting to the emergency department with dysphagia and confusion developed hematemesis while in the emergency department, requiring intubation and urgent endoscopy. Esophagogastroduodenoscopy and biopsy confirmed esophageal adenocarcinoma. The patient was extubated then reintubated due to recurrent hematemesis and continued to have bloody orogastric tube output. Multidisciplinary discussions between critical care, surgical oncology, medical oncology, radiation oncology, and gastroenterology, determined the patient was not a candidate for surgery, radiation, or chemotherapy given his clinical condition. Therefore, fluoroscopic guided endoscopic stenting was selected to control the bleeding. A 23 mm × 125 mm fully covered self-expanding metal stent was placed over a wire to cover the proximal portion of the esophageal mass. A smaller 18 mm × 119 mm metal stent was then placed distally through the initial stent in a telescopic fashion, using the esophagogastroduodenoscopy scope. No active bleeding was identified at the end of the procedure. Discussion: The patient had no evidence of rebleeding following endoscopic intervention and remained hemodynamically stable. He was later extubated and began radiation therapy. This case suggests that esophageal stenting as salvage therapy may be an effective intervention to achieve hemostasis in patients with active malignancy-related esophageal bleeds who are not candidates for additional therapy and act as a bridge to definitive treatment.