Late Obstruction After Esophageal Self-Expandable Metallic Stent Placement for Malignant Stenosis or Fistula:...

Self-expandable metallic stents (SEMSs) are widely used for palliation of malignant esophageal strictures and esophago-respiratory fistulas. As longer survival is achieved with contemporary systemic therapy, late complications, particularly stent obstruction, are increasingly reported.

We evaluated the outcomes and late complications of stent placement, focusing on obstruction.

This single-center, retrospective cohort study included patients who underwent SEMS placement for malignant esophageal strictures or fistulas between February 2009 and February 2024. Dysphagia severity and oral intake were assessed using dysphagia scores, and adverse events were recorded. Patients with or without obstruction were compared.

Among the 103 included patients (median age: 74 years, 76% male), 67% had primary esophageal cancer. The technical success rate was 99%, and one patient died from intraoperative perforation. The median dysphagia score improved from 3 to 1 after placement, and 94% of patients could swallow liquids. Overall, adverse events occurred in 24% of cases; early (≤ 30 days) events included perforation, migration, obstruction, pain, bronchial obstruction, and aspiration pneumonia, with two hospital deaths possibly procedure-related. Late (> 30 days) events included obstruction in 11 patients (11%) and migration in 2 patients (2%). Twelve cases of obstruction occurred (11 late, 1 early), 7 of which were caused by epithelial hyperplasia (58%), the most common cause. The median survival time was 85 days and was longer in obstruction cases.

Stent placement is effective and considered safe. As systemic therapy evolves and some patients survive longer, epithelial hyperplasia-related late obstruction has become clinically relevant.