Esophageal Stenting

An esophageal stent procedure is a relatively safe and effective method of palliation (improvement of symptoms) and treatment of esophageal disease. Esophageal stents are available in different types and in lengths ranging from 60 to 150 millimeters (2.4 to 5.9 inches), but most have a similar maximal internal diameter of 17 to 23 millimeters (0.67 to 0.9 inch). Esophageal stent placement is performed via an upper endoscopy. The majority of stents have a simple delivery system.

• Palliation (improvement of symptoms) of obstructing esophageal cancer
• Treatment of:
  • Peptic esophageal stricture
  • Esophageal perforation
  • Leak following esophageal surgery or gastric (stomach) surgery
  • Tracheoesophageal fistula

The stents can be placed temporarily or permanently, depending on indication.

The esophageal stent is placed via an upper endoscopy and the delivery system for most types of stents is simple to apply. The length of the stricture or area of concern is first measured and the appropriate stent length is selected. In general, we use an 18- to 23-millimeter (0.7 to 0.9 inch) diameter stent that is 1 to 2 centimeters (0.39 to 0.79 inch) longer than the stricture or area of concern to avoid infolding of the proximal and distal ends.

A guide wire is then passed through an upper endoscope into the esophagus. The delivery system is passed over the guide wire through the stricture or area of concern and the stent is deployed using fluoroscopy (X-ray guidance). Proper positioning and deployment are confirmed with X-ray and by reinserting the endoscope.

A barium esophagram is obtained if the stent is placed for an esophageal perforation or leak. If the esophagram shows no evidence of a leak following placement of the stent, the patient can start drinking. If the opening of the stricture is too small to accept the endoscope, the narrowing may require dilation. Over time, the stent expands inside the esophagus.

The risk of esophageal stent placement is variable for different type of stents and is known to include esophageal perforation and migration (the stent can move). The permanent stents have a risk of eroding into the surrounding tissues or may result in growth of the tumor into the stent. Overall, the use of esophageal stents in the treatment of patients with esophageal disease is growing.