Digestive Disease Interventions 2018; 02(01): 018-024
DOI: 10.1055/s-0038-1645853
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Stenting for Advanced Esophageal Carcinoma

Kun Yung Kim
1   Department of Radiology and Research Institute of Radiology, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
Ji Hoon Shin
1   Department of Radiology and Research Institute of Radiology, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
Jung-Hoon Park
1   Department of Radiology and Research Institute of Radiology, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
2   Biomedical Engineering Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

14 November 2017

14 March 2018

Publication Date:
30 April 2018 (online)


Esophageal cancer is the eighth most common malignancy and the sixth leading cause of cancer-related deaths worldwide. Most patients with esophageal cancer are identified at an advanced stage of disease. Less than 20% of patients are candidates for curable surgical resection. Self-expandable metallic stents (SEMSs) have recently been used for the palliation of incurable esophageal cancer. Since their use was first reported in the late 1970s, stents have evolved rapidly from rigid plastic tubes to flexible SEMSs. This review covers various aspects of SEMS placement for advanced esophageal cancer and discusses multiple types of SEMSs, considerations in stent placement, complications, and recently developed radiation-emitting stents.

  • References

  • 1 Pennathur A, Gibson MK, Jobe BA, Luketich JD. Oesophageal carcinoma. Lancet 2013; 381 (9864): 400-412
  • 2 Weigel TL, Frumiento C, Gaumintz E. Endoluminal palliation for dysphagia secondary to esophageal carcinoma. Surg Clin North Am 2002; 82 (04) 747-761
  • 3 Brierley JD, Oza AM. Radiation and chemotherapy in the management of malignant esophageal strictures. Gastrointest Endosc Clin N Am 1998; 8 (02) 451-463
  • 4 Domschke W, Foerster EC, Matek W, Rödl W. Self-expanding mesh stent for esophageal cancer stenosis. Endoscopy 1990; 22 (03) 134-136
  • 5 Hill JL, Norberg HP, Smith MD, Young JA, Reyes HM. Clinical technique and success of the esophageal stent to prevent corrosive strictures. J Pediatr Surg 1976; 11 (03) 443-450
  • 6 Martinez JC, Puc MM, Quiros RM. Esophageal stenting in the setting of malignancy. ISRN Gastroenterol 2011; 2011: 719575
  • 7 Dormann AJ, Eisendrath P, Wigginghaus B, Huchzermeyer H, Devière J. Palliation of esophageal carcinoma with a new self-expanding plastic stent. Endoscopy 2003; 35 (03) 207-211
  • 8 Szegedi L, Gál I, Kósa I, Kiss GG. Palliative treatment of esophageal carcinoma with self-expanding plastic stents: a report on 69 cases. Eur J Gastroenterol Hepatol 2006; 18 (11) 1197-1201
  • 9 Verschuur EM, Repici A, Kuipers EJ, Steyerberg EW, Siersema PD. New design esophageal stents for the palliation of dysphagia from esophageal or gastric cardia cancer: a randomized trial. Am J Gastroenterol 2008; 103 (02) 304-312
  • 10 Seven G, Irani S, Ross AS. , et al. Partially versus fully covered self-expanding metal stents for benign and malignant esophageal conditions: a single center experience. Surg Endosc 2013; 27 (06) 2185-2192
  • 11 Loizou LA, Rampton D, Bown SG. Treatment of malignant strictures of the cervical esophagus by endoscopic intubation using modified endoprostheses. Gastrointest Endosc 1992; 38 (02) 158-164
  • 12 Goldschmid S, Boyce Jr HW, Nord HJ, Brady PG. Treatment of pharyngoesophageal stenosis by polyvinyl prosthesis. Am J Gastroenterol 1988; 83 (05) 513-518
  • 13 Gislason GT, Pasricha PJ. Crossing the upper limit: esophageal stenting in the proximal esophagus. Dysphagia 1997; 12 (02) 84-85
  • 14 Verschuur EM, Kuipers EJ, Siersema PD. Esophageal stents for malignant strictures close to the upper esophageal sphincter. Gastrointest Endosc 2007; 66 (06) 1082-1090
  • 15 Choi EK, Song HY, Kim JW. , et al. Covered metallic stent placement in the management of cervical esophageal strictures. J Vasc Interv Radiol 2007; 18 (07) 888-895
  • 16 Gallo A, Pagliuca G, de Vincentiis M. , et al. Endoscopic treatment of benign and malignant strictures of the cervical esophagus and hypopharynx. Ann Otol Rhinol Laryngol 2012; 121 (02) 104-109
  • 17 Conio M, Caroli-Bosc F, Demarquay JF. , et al. Self-expanding metal stents in the palliation of neoplasms of the cervical esophagus. Hepatogastroenterology 1999; 46 (25) 272-277
  • 18 Battaglia G, Antonello A, Realdon S, Cavallin F, Giacomini F, Ishaq S. Feasibility, efficacy and safety of stent insertion as a palliative treatment for malignant strictures in the cervical segment of the esophagus and the hypopharynx. Surg Endosc 2016; 30 (01) 159-167
  • 19 Dua KS, Kozarek R, Kim J. , et al. Self-expanding metal esophageal stent with anti-reflux mechanism. Gastrointest Endosc 2001; 53 (06) 603-613
  • 20 Laasch HU, Marriott A, Wilbraham L, Tunnah S, England RE, Martin DF. Effectiveness of open versus antireflux stents for palliation of distal esophageal carcinoma and prevention of symptomatic gastroesophageal reflux. Radiology 2002; 225 (02) 359-365
  • 21 Sabharwal T, Gulati MS, Fotiadis N. , et al. Randomised comparison of the FerX Ella antireflux stent and the ultraflex stent: proton pump inhibitor combination for prevention of post-stent reflux in patients with esophageal carcinoma involving the esophago-gastric junction. J Gastroenterol Hepatol 2008; 23 (05) 723-728
  • 22 Sharma P, Kozarek R. ; Practice Parameters Committee of American College of Gastroenterology. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol 2010; 105 (02) 258-273 , quiz 274
  • 23 Uitdehaag MJ, Siersema PD, Spaander MC. , et al. A new fully covered stent with antimigration properties for the palliation of malignant dysphagia: a prospective cohort study. Gastrointest Endosc 2010; 71 (03) 600-605
  • 24 Uitdehaag MJ, van Hooft JE, Verschuur EM. , et al. A fully-covered stent (Alimaxx-E) for the palliation of malignant dysphagia: a prospective follow-up study. Gastrointest Endosc 2009; 70 (06) 1082-1089
  • 25 Verschuur EM, Homs MY, Steyerberg EW. , et al. A new esophageal stent design (Niti-S stent) for the prevention of migration: a prospective study in 42 patients. Gastrointest Endosc 2006; 63 (01) 134-140
  • 26 Walter D, van den Berg MW, van Hooft JE. , et al. A new fully covered metal stent with anti-migration features for the treatment of malignant dysphagia. Endoscopy 2014; 46 (12) 1101-1105
  • 27 Kjaer DW, Nassar M, Jensen LS, Svendsen LB, Mortensen FV. A bridging stent to surgery in patients with esophageal and gastroesophageal junction cancer has a dramatic negative impact on patient survival: a retrospective cohort study through data acquired from a prospectively maintained national database. Dis Esophagus 2017; 30 (03) 1-7
  • 28 Mariette C, Gronnier C, Duhamel A. , et al; FREGAT Working Group–FRENCH–AFC; FREGAT Working Group-FRENCH-AFC. Self-expanding covered metallic stent as a bridge to surgery in esophageal cancer: impact on oncologic outcomes. J Am Coll Surg 2015; 220 (03) 287-296
  • 29 Vleggaar FP. Stent placement in esophageal cancer as a bridge to surgery. Gastrointest Endosc 2009; 70 (04) 620-622
  • 30 Shin JH, Song HY, Kim JH. , et al. Comparison of temporary and permanent stent placement with concurrent radiation therapy in patients with esophageal carcinoma. J Vasc Interv Radiol 2005; 16 (01) 67-74
  • 31 Park JH, Song HY, Park JY. , et al. Temporary stent placement with concurrent chemoradiation therapy in patients with unresectable oesophageal carcinoma: is there an optimal time for stent removal?. Eur Radiol 2013; 23 (07) 1940-1945
  • 32 Park JH, Song HY, Shin JH. , et al. Preliminary results of temporary placement of retrievable expandable metallic stents during preoperative neoadjuvant chemoradiotherapy in patients with resectable esophageal cancer. J Vasc Interv Radiol 2015; 26 (06) 883-888
  • 33 Shin JH, Song HY, Ko GY, Lim JO, Yoon HK, Sung KB. Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology 2004; 232 (01) 252-259
  • 34 Balazs A, Kupcsulik PK, Galambos Z. Esophagorespiratory fistulas of tumorous origin. Non-operative management of 264 cases in a 20-year period. Eur J Cardiothorac Surg 2008; 34 (05) 1103-1107
  • 35 Chen YH, Li SH, Chiu YC. , et al. Comparative study of esophageal stent and feeding gastrostomy/jejunostomy for tracheoesophageal fistula caused by esophageal squamous cell carcinoma. PLoS One 2012; 7 (08) e42766
  • 36 May A, Ell C. Palliative treatment of malignant esophagorespiratory fistulas with Gianturco-Z stents. A prospective clinical trial and review of the literature on covered metal stents. Am J Gastroenterol 1998; 93 (04) 532-535
  • 37 Sarper A, Oz N, Cihangir C, Demircan A, Isin E. The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas. Eur J Cardiothorac Surg 2003; 23 (05) 794-798
  • 38 Saxon RR, Barton RE, Katon RM. , et al. Treatment of malignant esophagorespiratory fistulas with silicone-covered metallic Z stents. J Vasc Interv Radiol 1995; 6 (02) 237-242
  • 39 Van Heel NC, Haringsma J, Spaander MC, Didden P, Bruno MJ, Kuipers EJ. Esophageal stents for the palliation of malignant dysphagia and fistula recurrence after esophagectomy. Gastrointest Endosc 2010; 72 (02) 249-254
  • 40 Na HK, Song HY, Kim JH. , et al. How to design the optimal self-expandable oesophageal metallic stents: 22 years of experience in 645 patients with malignant strictures. Eur Radiol 2013; 23 (03) 786-796
  • 41 Conigliaro R, Battaglia G, Repici A. , et al. Polyflex stents for malignant oesophageal and oesophagogastric stricture: a prospective, multicentric study. Eur J Gastroenterol Hepatol 2007; 19 (03) 195-203
  • 42 Yakami M, Mitsumori M, Sai H, Nagata Y, Hiraoka M, Nishimura Y. Development of severe complications caused by stent placement followed by definitive radiation therapy for T4 esophageal cancer. Int J Clin Oncol 2003; 8 (06) 395-398
  • 43 Spaander MC, Baron TH, Siersema PD. , et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48 (10) 939-948
  • 44 Tahiri M, Ferraro P, Duranceau A, Berthiaume M, Thiffault V, Liberman M. Self-expanding metallic stent placement with an exaggerated 5-cm proximal tumor covering for palliation of esophageal cancer. Ann Gastroenterol 2015; 28 (03) 347-352
  • 45 Schowengerdt CG. Tracheoesophageal fistula caused by a self-expanding esophageal stent. Ann Thorac Surg 1999; 67 (03) 830-831
  • 46 Nagahama T, Maruyama M, Kato K. , et al. Complication after self expandable metallic stent for esophageal cancer [in Japanese]. Gan To Kagaku Ryoho 2003; 30 (11) 1750-1753
  • 47 Saito Y, Tanaka T, Andoh A. , et al. Novel biodegradable stents for benign esophageal strictures following endoscopic submucosal dissection. Dig Dis Sci 2008; 53 (02) 330-333
  • 48 Jung GE, Sauer P, Schaible A. Tracheoesophageal fistula following implantation of a biodegradable stent for a refractory benign esophageal stricture. Endoscopy 2010; 42 (Suppl. 02) E338-E339
  • 49 Bergquist H, Wenger U, Johnsson E. , et al. Stent insertion or endoluminal brachytherapy as palliation of patients with advanced cancer of the esophagus and gastroesophageal junction. Results of a randomized, controlled clinical trial. Dis Esophagus 2005; 18 (03) 131-139
  • 50 Homs MY, Steyerberg EW, Eijkenboom WM. , et al. Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet 2004; 364 (9444): 1497-1504
  • 51 Guo JH, Teng GJ, Zhu GY, He SC, Deng G, He J. Self-expandable stent loaded with 125I seeds: feasibility and safety in a rabbit model. Eur J Radiol 2007; 61 (02) 356-361
  • 52 Guo JH, Teng GJ, Zhu GY. , et al. Self-expandable esophageal stent loaded with 125I seeds: initial experience in patients with advanced esophageal cancer. Radiology 2008; 247 (02) 574-581
  • 53 Zhu HD, Guo JH, Mao AW. , et al. Conventional stents versus stents loaded with (125)iodine seeds for the treatment of unresectable oesophageal cancer: a multicentre, randomised phase 3 trial. Lancet Oncol 2014; 15 (06) 612-619
  • 54 Lei L, Liu X, Guo S, Tang M, Cheng L, Tian L. 5-Fluorouracil-loaded multilayered films for drug controlled releasing stent application: drug release, microstructure, and ex vivo permeation behaviors. J Control Release 2010; 146 (01) 45-53
  • 55 Zhang Y, Gao Y, Chen J. , et al. Effect of a paclitaxel-eluting metallic stent on rabbit esophagus. Exp Ther Med 2016; 12 (05) 2928-2936
  • 56 Zhang Y, Ma L, Huang J, Shuang J, Chen J, Fan Z. The effect of paclitaxel-eluting covered metal stents versus covered metal stents in a rabbit esophageal squamous carcinoma model. PLoS One 2017; 12 (03) e0173262