S4341 External Constriction of Esophageal Stent by Food Bolus Impaction After Cancer Treatment: A Rare Complication

Introduction: Delayed esophageal stent complications are defined as complications occurring 2-4 weeks after stent placement. The most common ones are tumor ingrowth, food bolus impaction, and stent migration. Here, we report a rare case of delayed stent complication involving external constriction of stent due to a development of surrounding food bolus from tumor shrinking after chemotherapy and radiation treatment, leading to worsening dysphagia 6 months after stent placement. Case Description/Methods: A 72-year-old man with a past medical history of T3N1 esophageal adenocarcinoma in the distal esophagus who received a fully covered metal stent with Over-the-Scope Clips StentFix® placement at the distal esophagus 6 months ago, presented for dysphagia and vomiting. He was initially tolerating orals and completed chemotherapy with 28 rounds of radiation treatment 2 months ago. He was last informed by his oncologist that his “mass was shrinking”. He then developed gradual worsening dysphagia to solids over the past few weeks, with acute dysphagia to liquids within the last 3 days. Computed tomography imaging demonstrated narrowing of the area of stent with almost complete obstruction of the esophageal lumen. An esophagogastroduodenoscopy showed impacted food between the esophageal wall and the stent, causing external compression of the stent with almost complete obstruction. A large amount of food was noted to be circumferentially adherent to the wall of the esophagus at the location of the previously placed stent which was then removed. The stent was removed, and the decision was made not to place another one as the prior mass was no longer obstructing the esophagus. Patient tolerated orals well after the procedure, and was advised to be on a soft diet. Discussion: In our case, tumor shrinking from chemotherapy lead to the stent not exerting significant force on the esophageal wall, creating an opening to develop between the esophageal lumen and the stent that allowed food to accumulate, resulting in external compression of the stent. It is rare for impaction to develop circumferentially around the stent due to shrinking of tumor, we were not able to find any similar case in the literature. In our patient, discussion of timing of stent removal should have been considered. Optimal timing of stent removal depend on the reasoning of placing the stent, with some guidelines suggesting to keep esophageal stents for no more than 12 weeks to prevent higher rates of complications.