Fully Covered Esophageal Self-Expanding Metal Stents Associated With Stent Migration Risk

Induction Chemotherapy to Downstage Advanced Oesophageal Cancer Before Surgery
Induction Chemotherapy to Downstage Advanced Oesophageal Cancer Before Surgery
Further study is required to establish optimal strategy for the palliation of malignant dysphagia.

Patients with partially covered self-expanding metal stents (SEMS) experienced lower rates of stent migration, but similar rates of obstruction compared with patients with fully covered SEMS. These findings from a retrospective study were published in Clinical Gastroenterology and Hepatology.

Patients (N=357) who underwent stent placement for malignant esophageal obstruction between 2007 and 2017 at 3 participating academic medical centers (Washington University, the University of Pennsylvania, and the Mayo Clinic) were recruited. Participants were assessed for risk for epithelial hyperplasia, risk for stent migration, and time to stent migration.

Mean patient age at the time of procedure was 67.7±12.9 years; 23.8% of patients were women, and most patients (74.8%) had stage IV malignancy at the time of the procedure. Patients had partially covered SEMS (61.9%), fully covered SEMS (22.1%), and fully covered SEMS with antimigration fins (16%) for treatment of esophageal adenocarcinomas (52.1%), esophageal squamous cell cancers (18.8%), gastroesophageal junction adenocarcinomas (13.2%), lung cancers (9.5%), other cancers (3.6%), breast cancers (1.7%), or head and neck squamous cell cancers (1.1%).

All procedures were considered a technical success for initial stent placement. Stent migration occurred in 15.4% of patients. The SEMS migration was caused by epithelial hyperplasia and/or food impaction. Nearly one-third of patients (32.8%) required a repeat procedure.

Stent migration was significantly more frequent for fully covered than for partially covered stents (25.3% vs 10.9%; P <.003) but not for stents with antimigration fins (19.3%). The median time to migration did not differ by stent type (P =.096). The observed time to migration was 37 days (interquartile range [IQR], 14.2-59.8), 23 days (IQR, 0-58.1), and 63 days (IQR, 0-135.3) for partially covered, fully covered, and fully covered with antimigration fins, respectively.

Risk for migration was higher among patients with stricture traversability (odds ratio [OR], 2.37; 95% CI, 1.29-4.35), as well as among those who received a fully covered SEMS (OR, 2.56; 95% CI, 1.31-5.00) or with antimigration fins (OR, 2.30; 95% CI, 1.03-5.14).

Following the procedure, the median overall survival was 79 days (IQR, 41-199). Patients had a survival rate of 80.4% at 30 days and 49.9% at 90 days.

This study was limited by the fact that patients were not randomized, indicating that some selection bias may have been introduced.

The study authors concluded that fully covered stents were more likely to migrate than partially covered SEMS. Risk for a stent migration was higher among patients with stricture traversability.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Das KK, Hasak S, Elhanafi S, et al. Performance and predictors of migration of partially and fully covered esophageal self-expanding metal stents for malignant dysphagia. Published online September 5, 2020. Clin Gastroenterol Hepatol. doi: 10.1016/j.cgh.2020.09.010