Safety and Efficacy of Conventional and Segmented Esophageal Fully Covered Self-expanding Metals Stents: a Retrospective Multicenter Case-Control Study

Aims Fully covered self-expanding metal stents (fcSEMS) are commonly used to treat malignant as well as refractory benign esophageal stenosis. Segmented fcSEMS are a variant of conventional unsegmented fcSEMS that may be more migration-resistant and atraumatic. Comparison of segmented and conventional/unsegmented fcSEMS with regard to efficacy (technical success and migration rate) and severe adverse events (stent-associated bleeding and perforation).

Methods Multicenter (3 centers in Germany) retrospective case-control study. We included both benign and malignant esophageal stenosis. All patients that received an unsegmented fcSEMS in 2012-2022 and had sufficient clinical data available were included and matched 1:1 to a patient treated with a conventional fcSEMS.

Results In total 158 patients were analyzed, i.e. 79 each with conventional fcSEMS and with segmented fcSEMS. The mean follow-up was 137 days. Of the stenosis included 24% were benign and 76% were malignant. 17% had a surgically altered esophageal anatomy. The technical success rate was 100% in both groups. Stent migration occurred in 26.6% (segmented fcSEMS) and 22.8% (conventional fcSEMS); this difference was not statistically significant. However, severe stent-associated adverse events (clinically significant bleeding and perforation) occurred more frequently in the conventional fcSEMS compared to the segmented fcSEMS group with 3.8% vs. 13.9%; this difference was borderline significant (p=0.05; chi-square with Yates’ correction). In the subset with malignant disease there was no difference between the groups with regard to survival.

Conclusions In this multicentric retrospective cohort segmented fcSEMS were comparable to conventional fcSEMS in terms of technical success and efficacy while the rate of severe adverse events was reduced.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024