Esophageal stent-related adverse events common but manageable

Last Updated: 2017-01-16

By Reuters Staff

NEW YORK (Reuters Health) - Adverse events are common in patients with long-term self-expandable esophageal metallic stents for advanced malignant disease, but most can be successfully managed by endoscopy.

Self-expandable metallic stents (SEMSs) are commonly used to treat dysphagia in patients with advanced esophageal cancer. The reported incidence of long-term stent-related adverse events varies widely in the literature, with most data coming from relatively small groups of patients followed for only a few months.

Dr. Bruno da Costa Martins and colleagues from Cancer Institute of the University of São Paulo, Brazil, evaluated adverse events rates in a retrospective analysis of 63 patients who survived longer than six months with esophageal stents in place.

After a median follow-up of 10.7 months, 37 patients (58.7%) still had a functioning stent and were accepting oral intake, the researchers report in Gastrointestinal Endoscopy, online December 23.

Nearly two-thirds of patients (40/63, 63.5%) experienced adverse events, most of them (75.8%) minor, such as pain, reflux, stent migration and overgrowth.

Major adverse events included 13 esophageal fistulas and two bleeding episodes. Endoscopic treatment was attempted in nine of these cases, with success in six

Overall, 34 of the 63 patients had to undergo endoscopic reintervention (mean, 1.6 reinterventions per patient), and 84.8% of all adverse events could be managed clinically or endoscopically with success.

Three major adverse events were fatal, including two patients with esophagorespiratory fistulas who died due to pulmonary sepsis and one patient who died because of tumor bleeding.

ECOG status was the only factor associated with adverse events on multivariate analysis.

The median survival of patients with adverse events (13.2 months) was significantly longer than that of patients without adverse events (7.9 months). The researchers attribute this finding to the fact that patients who survived longer had more time to experience adverse events.

"Our data suggest that metallic stenting is a valid option for the treatment of malignant esophageal conditions, even when survival longer than 6 months as expected," they conclude.

Dr. Martins was not available for comment.

SOURCE: http://bit.ly/2iymC7X

Gastrointest Endosc 2016.