From Migration to Emergency: A Systematic Review of Acute Presentations Following Late Esophageal Stent Migration

Background: Self-expanding esophageal stents (SEMS) are widely used in the management of malignant dysphagia and a variety of benign esophageal conditions. Although stent migration is a well-recognized complication, late migration -defined as occurring ≥4 weeks after stent placement- is less well characterized and may result in severe, life-threatening emergencies. These events are frequently underrecognized and not consistently addressed within current surveillance practice. Methods: A systematic review was conducted in PubMed/MEDLINE, Embase, and Scopus databases focusing on acute clinical presentations following late esophageal stent migration. Results: Out of 343 unique articles, 53 studies were included, involving 53 patients with a median time to presentation of 3 months after stent placement, and 12.5% of cases occurring more than one year later. The gastrointestinal tract was the most frequent site of migration (64.2%), followed by airway/respiratory (15%), thoracic (13.2%), and vascular structures (5.7%). Clinical presentations included small bowel obstruction (30.2%), gastrointestinal or thoracic perforation, respiratory failure, sepsis, and catastrophic hemorrhage. Surgical intervention was required in most cases. Overall mortality was 28.3%, with especially poor outcomes in cases complicated by vascular or airway involvement. Conclusions: Late esophageal stent migration represents a clinically significant but underrecognized cause of acute surgical emergencies. Risk-adapted surveillance, prompt diagnostic imaging, and early multidisciplinary management are essential to improve outcomes and enhance the long-term safety of esophageal stent therapy.