Adverse Events With Esophageal Stenting: A Call to Optimize Device and Endoscopic Placement

Abstract

Background and Aims

Despite technological and procedural improvements, esophageal stents (ESs) have high rates of adverse events (AEs), including stent migration, recurrent stenosis, and chest pain. We sought to evaluate predictors and causes for early readmission following ES placement in hospitalized patients.

Methods

The National Readmission Database 2016-2018 was queried to identify hospitalized patients with an ICD-10-CM code for endoscopic ES placement. Primary outcome was early (≤ 30-day) readmission rate. Univariate and multivariable logistic regression models were used to evaluate predictors of early readmission.

Results

A total of 949 patients underwent index ES placement, and most (67%, n = 634) patients had benign indications. Overall, the most common indication was benign esophageal leak/fistula (n = 359), followed by malignant dysphagia from esophageal neoplasm (n = 252). The 30-day readmission rate was 26% (n = 251), with higher rates for benign (29%) compared with malignant (22%) indications (P = 0.09). An analysis of primary diagnosis for early readmissions revealed that stent-related AEs were higher in the benign than in the malignant group (42% vs 23%, respectively; P = 0.008). Multivariable analysis revealed that ES placement for esophageal leak/fistulas (OR = 1.98; 95% CI, 1.20-3.24; P = 0.022) was the only significant variable associated with early readmission.

Conclusion

In recent years, inpatient ESs have been placed predominantly in patients with benign conditions, with esophageal leak/fistula being the most common indication. Stent-related AEs account for a significant burden of readmissions, particularly when placed for benign conditions. There is a need for focused research to refine indications, optimize techniques, and improve stent technology.