Endoscopy 2004; 36(10): 880-886
DOI: 10.1055/s-2004-825855
Original Article
© Georg Thieme Verlag Stuttgart · New York

Causes and Treatment of Recurrent Dysphagia after Self-Expanding Metal Stent Placement for Palliation of Esophageal Carcinoma

M.  Y.  V.  Homs1 , E.  W.  Steyerberg2 , E.  J.  Kuipers1 , A.  van der Gaast3 , J.  Haringsma1 , M.  van Blankenstein1 , P.  D.  Siersema1
  • 1Dept. of Gastroenterology and Hepatology, Erasmus MC University, Medical Center Rotterdam, Netherlands
  • 2Dept. of Public Health, Erasmus MC University, Medical Center Rotterdam, Netherlands
  • 3Dept. of Oncology, Erasmus Medical Center, Erasmus University, Rotterdam, Netherlands
Further Information

Publication History

Submitted 17 December 2003

Accepted after Revision 15 June 2004

Publication Date:
28 September 2004 (online)

Background and Study Aims: Recurrent dysphagia frequently complicates the palliative treatment of esophageal cancer with self-expanding metal stents. Strategies for repeat interventions and subsequent outcomes have not been adequately reported to date.
Patients and Methods: A total of 216 patients underwent placement of a self-expanding metal stent (Ultraflex, n = 75; Flamingo Wallstent, n = 71; Z-stent, n = 70) for malignant dysphagia, and were followed up prospectively. The causes of stent-related recurrent dysphagia, the intervals after first stent placement, and the procedures used for repeat intervention and their outcomes were evaluated.
Results: Seventy-four episodes of stent-related recurrent dysphagia occurred in 63 patients (29 %), mainly due to tumor overgrowth (n = 30; median 129 days), stent migration (n = 26; median 92 days) and food bolus obstruction (n = 16; median 80 days). Stent migration occurred more frequently (P = 0.05), whereas tumor overgrowth occurred less frequently (P = 0.05) with Ultraflex stents in comparison with Flamingo Wallstents and Z-stents. Tumor overgrowth was treated in 25 patients mainly by a second stent (n = 19) and was effective in 23 of the 25 patients (92 %). Five patients received no further treatment. Stent migration was treated by placing a second stent (n = 14), repositioning the migrated stent (n = 7), other treatments (n = 3), or no further treatment (n = 2), and treatment was effective in 20 of 24 (83 %) patients. Food bolus obstruction was treated by endoscopic stent clearance in all patients. Repeat intervention for stent-related recurrent dysphagia improved the dysphagia score from a median of 3 to 1 (P < 0.001). The median survival period after repeat treatment was 68 days.
Conclusions: Recurrent dysphagia occurs in almost one-third of patients after stent placement. Repeat interventions for stent-related recurrent dysphagia are effective in over 90 % of patients. New innovations in stent design are needed to reduce the risk of stent-related recurrent dysphagia.

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P. D. Siersema, M. D.

Dept. of Gastroenterology and Hepatology, Erasmus MC University, Medical Center Rotterdam

P.O. Box 2040 · 3000 CA Rotterdam · The Netherlands

Fax: + 31-10 463 4682 ·

Email: p.siersema@erasmusmc.nl