Palliation of Neoplastic Esophageal Strictures with Metallic Stents

Most patients with advanced esophageal neoplasm have dysphagia and suffer from cachexia and malnourishment. Supportive treatments focus on symptom palliation and improving quality of life at this time. Guidelines illustrated some indications for stent use in esophageal neoplasm such as inoperable neoplastic obstruction, presence of neoplastic fistula or perforation, tumor recurrence and contraindication for chemo-radiotherapy. Palliative stents help relieve dysphagia, manage mouth secretions, reduce aspiration risk, and maintain oral intake. Stent placement sometimes requires both endoscopic and fluoroscopic guidance. A stricture dilation is not necessary before stent placement. Success rate of SEMS placement was reported 80-100%. Complications of stents are bleeding, perforation, migration, and tumor ingrowth. Coated SEMS are the treatment of choice in the presence of neoplastic trachea-esophageal fistula. Partially covered stents are used for neoplastic stricture but their removal is sometimes difficult. The stent can be left in esophagus indefinitely for palliation in cases with progressive disease. In this article, we reviewed the recent literatures for efficacy of palliative metal stents placement in patients with esophageal neoplasm.