Endoscopy 2016; 48(10): 939-948
DOI: 10.1055/s-0042-114210
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

Manon C. W. Spaander
1  Department of Gastroenterology and Hepatology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
,
Todd H. Baron
2  Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
,
Peter D. Siersema
3  Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
,
Lorenzo Fuccio
4  Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
,
Brigitte Schumacher
5  Klinik für Innere Medizin und Gastroenterologie, Elisabeth Krankenhaus Essen, Essen, Germany
,
Àngels Escorsell
6  Liver Unit, Hospital Clínic, Barcelona, Spain
,
Juan-Carlos Garcia-Pagán
6  Liver Unit, Hospital Clínic, Barcelona, Spain
,
Jean-Marc Dumonceau
7  Gedyt Endoscopy Center, Buenos Aires, Argentina
,
Massimo Conio
8  Department Gastroenterology and Endoscopy, Ospedale di Sanremo, Sanremo, Italy
,
Antonella de Ceglie
9  Department of Gastroenterology, National Cancer Institute, Bari, Italy
,
Janusz Skowronek
10  Brachytherapy Department, Greater Poland Cancer Center, Poznan, Poland; Electroradiology Department, Poznan University of Medical Sciences, Poland
,
Marianne Nordsmark
11  Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
,
Thomas Seufferlein
12  Department of Internal Medicine I, Ulm University, Ulm, Germany
,
André Van Gossum
13  Department of Gastroenterology and Hepatology, Hôpital Erasme, Free University of Brussels, Brussels, Belgium.
,
Cesare Hassan
14  Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy
,
Alessandro Repici
15  Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
,
Marco J. Bruno
1  Department of Gastroenterology and Hepatology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
14 September 2016 (eFirst)

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE), endorsed by the European Society for Radiotherapy and Oncology (ESTRO), the European Society of Digestive Endoscopy (ESDO), and the European Society for Clinical Nutrition and Metabolism (ESPEN). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.

Main recommendations for malignant disease

1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliative treatment of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass (strong recommendation, high quality evidence).

2 For patients with longer life expectancy, ESGE recommends brachytherapy as a valid alternative or in addition to stenting in esophageal cancer patients with malignant dysphagia. Brachytherapy may provide a survival advantage and possibly a better quality of life compared to SEMS placement alone. (Strong recommendation, high quality evidence.)

3 ESGE recommends esophageal SEMS placement as the preferred treatment for sealing malignant tracheoesophageal or bronchoesophageal fistula (strong recommendation, low quality evidence).

4 ESGE does not recommend the use of concurrent external radiotherapy and esophageal stent treatment. SEMS placement is also not recommended as a bridge to surgery or prior to preoperative chemoradiotherapy. It is associated with a high incidence of adverse events and alternative satisfactory options such as placement of a feeding tube are available. (Strong recommendation, low quality evidence.)

Main recommendations for benign disease

1 ESGE recommends against the use of self-expandable stents (SEMSs) as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and costs (strong recommendation, low quality evidence).

2 ESGE suggests consideration of temporary placement of SEMSs as therapy for refractory benign esophageal strictures (weak recommendation, moderate evidence).

Stents should usually be removed at a maximum of 3 months (strong recommendation, weak quality evidence).

3 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures, because of their lack of embedment and ease of removability (weak recommendation, low quality evidence).

4 For the removal of partially covered esophageal SEMSs that are embedded, ESGE recommends the stent-in-stent technique (strong recommendation, low quality evidence).

5 ESGE recommends that temporary stent placement can be considered for treating esophageal leaks, fistulas, and perforations. The optimal stenting duration remains unclear and should be individualized. (Strong recommendation, low quality evidence.)

6 ESGE recommends placement of a SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive esophageal variceal bleeding (strong recommendation, moderate quality evidence).

Appendix e1, e2, e3