Endoscopic Esophageal Stenting
Advances in chemo-radiotherapy and cancer surgery are changing the landscape of esophageal stent insertion. Where previously patients received stents for end-stage esophageal carcinoma with a poor prognosis, long-term survival is beginning to become the norm. In addition more patients are undergoing radical surgery and consequently more patients are presenting with disease relapse in altered anatomy. Furthermore, patients with extra-esophageal cancer can require stent insertion, but their underlying disease may run a different course from esophageal cancer.
Esophageal stents can be placed endoscopically or radiologically and the techniques are well established. Esophageal stents are commonly used for benign esophageal pathology, especially strictures or esophageal mucosal defects such as leaks, fistulae, or perforations. The use of removable, fully covered self-expanding metal stents (FCSEMS) in the management of benign esophageal pathology has been increasingly applied in recent years. Several studies have shown promising results with its application in esophageal perforation, fistula, or leak, and refractory benign strictures. However, the major limiting factor to successful treatment with FCSEMS in this setting is the substantial migration rates.
How it is performed?
General anesthesia or conscious sedation will be started and an upper endoscope will be inserted into the patient’s mouth and advanced into the stomach. Endoscopic stenting with a fully covered self-expanding metal stents (FCSEMS) will then be performed. Once the stent is in place, the endoscope will be withdrawn from the patient to set-up the endostitch device unto the endoscope. Bites are taken separately with the first on the esophageal mucosa followed by a second on the stent itself and finishing with a last bite on esophageal mucosa. A cinch is then used to secure the deployed suture. An attempt at placing 2 sutures will be performed. Stent removal will then be performed at 8-weeks post-stent insertion.