title: Esophageal stenting for malignant and benign disease: 133 cases on a thoracic surgical service.
abstract: BACKGROUND
  Esophageal stenting is increasingly being utilized to treat a variety of benign and malignant esophageal conditions. The aim of our study was to review our experience with self-expanding metal, plastic, and hybrid stents in the treatment of esophageal disease on a thoracic surgical service.
  
  
  METHODS
  The study population consisted of 126 patients undergoing placement of 133 stents at a single institution from 2000 to 2008. Data were reviewed retrospectively for patient characteristics, indications, complications, reinterventions, and efficacy.
  
  
  RESULTS
  Most stents were placed for palliation of dysphagia due to advanced esophageal cancer (90 of 133; 68%) or extrinsic compression from lung cancer (13 of 133; 9.8%). A total of 123 self-expanding metal stents (SEMS), 7 self-expanding plastic stents (SEPS), and 3 hybrid stents were placed. Of the SEMS, 57 were uncovered and 66 were covered. Malignant obstruction was typically palliated with SEMS, while covered stents were chosen for perforations or anastomotic leaks. The median length of stay was 1 day. Complications occurred in 38.3% of stent placements, with a single perioperative mortality resulting from massive hemorrhage on postoperative day 4. Most complications resulted from stent impaction (12.8%), migration (9.7%), or tumor ingrowth (5.3%). Tumor ingrowth was uncommon with uncovered stents (2 of 57; 3.5%). Stent migration was common with SEPS (4 of 7; 57%), or hybrid stents (2 of 3; 67%). Survival was short in patients with underlying malignancy (median 104 days for esophageal cancer and 48 days for lung cancer), with 20% of patients surviving less than 1 month.
  
  
  CONCLUSIONS
  Esophageal stent placement is safe and reliable. The goals of therapy are typically met with a single intervention. The majority of patients require no further interventions, though life expectancy often is short and patient selection may be difficult. Most complications are due to stent obstruction, though stent migration is an issue particularly with SEPS and hybrid stents. Esophageal surgeons should be adept at stent placement.
authors: Division of Thoracic and Foregut, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. dubeczattila@gmail.com
authors: Attila
authors: A
authors: Dubecz
authors: Thomas J
authors: TJ
authors: Watson
authors: Daniel P
authors: DP
authors: Raymond
authors: Carolyn E
authors: CE
authors: Jones
authors: Alexi
authors: A
authors: Matousek
authors: Julie
authors: J
authors: Allen
authors: Renato
authors: R
authors: Salvador
authors: Marek
authors: M
authors: Polomsky
authors: Jeffrey H
authors: JH
authors: Peters
mesh_terms: D000368:Aged; D004935:Esophageal Diseases / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects