title: Gastric ulceration following oesophageal stent migration complicating surgical management of oesophageal cancer.
abstract: Oesophageal, fully covered self-expanding metal stents (SEMS) allow palliation of dysphagia so as to support nutrition during neoadjuvant therapy. We present a 68-year old man with an oesophageal adenocarcinoma (T3N1M0) who had a fully covered oesophageal SEMS placed prior to neoadjuvant chemoradiotherapy. Repeat endoscopy 8 weeks later (for stent removal) showed that the stent had migrated and impacted upon the greater curvature of the stomach with a resultant ulcer. Surgery was delayed and, 10 weeks following the cessation of neoadjuvant chemoradiotherapy, this patient underwent a right thoracoabdominal oesophagogastrectomy. Operative findings included an erosion of the stent-induced gastric ulcer into the body of the pancreas and showed that the ulcerated tumour had become adherent to the thoracic aorta. This report demonstrates that the complications of stent migration can significantly impact upon surgical resection at multiple levels and provides a case for the routine removal of stents used in the neoadjuvant setting.
authors.affiliation: Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA 98111, USA.
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.forename: Andrew
authors.initials: A
authors.lastname: Ross
authors.forename: Donald E
authors.initials: DE
authors.lastname: Low
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery / Q000628:therapy*; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery / Q000628:therapy*; D016629:Esophagectomy; D004945:Esophagoscopy / Q000009:adverse effects / Q000295:instrumentation; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005743:Gastrectomy; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D010166:Palliative Care; D015607:Stents; D013276:Stomach Ulcer / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome