Esophageal stents in malignant dysphagia: a two-edged sword?

Dysphagia from mechanical esophageal obstruction in patients with advanced malignancy is a common and debilitating symptom in patients referred to palliative care services. Relief of such dysphagia is often attempted by insertion of an esophageal stent in the hope that this will improve the quality of life for these patients. We describe a series of 39 patients who had an esophageal stent inserted under radiologic guidance for malignant dysphagia over an 82-month period. While the stents were clearly effective at relieving dysphagia, they also induced significant comorbidity, in particular, moderate to severe chest pain occurring in 46% and reflux esophagitis in 26% of our non-selected patient group. In addition we found an eight percent mortality rate from esophageal bleeding following stent insertion. When discussing the potential role of esophageal stent insertion with patients under the care of palliative care teams, the frequency and severity of these significant secondary symptoms need to be considered.