Clinical applications of esophageal stents

Abstract

Esophageal stents have been in surgical practice for over a century and continue to advance. Their use has led to changes in treatment paradigms and improved outcomes for a myriad of esophageal diseases. A variety of stents are used in the palliation of dysphagia in patients with malignant disease as well as part of a treatment plan in those with benign conditions. All stent placements begin with upper endoscopy in order to determine exact location of the pertinent pathology and use of a guidewire to set up for stent placement by the chosen technique. The type of stent chosen can vary based upon the etiology and presentation of each patient. In addition to stents that are commonly used today in management of patients, some of the newest developments in stent technology include 3D custom printed stents, biodegradable stents for benign strictures, or incorporating other therapeutic adjuncts to permit the slow-release of anti-cancer drugs. While complications during esophageal stent placement are rare, patients can experience bleeding or pain. These are generally self-limited. The most common complication is stent migration, which can be reduced with endoscopic fixation techniques. Much less common, but significantly more complex, is erosion through the esophagus. As surgical care continues to move towards less invasive approaches, endoscopic stent placement will continue to be a great option for numerous esophageal diseases. New opportunities for technological advancements are emerging that may further change current treatment algorithms for both malignant and benign pathologies. This may further give way to improved long-term outcomes or expansion of treatment options for patients.