Non-malignant obstruction is a common problem with metal stents in the treatment of esophageal cancer

Introduction: The use of metal esophageal stents for the treatment of malignant dysphagia is an important advance because of their ease of delivery and their self-expandable property. Obstruction due to tumor overgrowth (TO) is a recognized complication. We report 23 patients with esophageal cancer and stents who developed dysphagia and obstruction not related to tumor overgrowth, but due to non-malignant tissue growth caused by the stent. AIM: To retrospectively assess the frequency of non-malignant obstruction (NMO) in patients with metal stents and esophageal cancer. Methods: Patients from the ASGE database at Georgetown University Medical Center with esophageal cancer and metal stents were reviewed. Results: A total of 82 patients from October of 1993 to October of 1997 were included. Four types of metal stents were used (Ultraflex, Z stent, Wallstent, In-stent). Forty-nine (60%) stent obstructions were reported, of which 26(31%) were due to TO and 23(28%) were not associated to malignancy. Histology analysis of the NMO was reported as granulation tissue (57%), reactive hyperplasia (21.5%) and fibrosis (21.5%) Some characteristics of the population with obstruction are given below: CHARACTERISTICS NMO (%) TO (%) Males 65 68 Females 35 32 Squamous cell carcinoma 69 74 Adenocarcinoma 31 26 Previous Radiotherapy 78 73 Previous Chemotherapy 78 69 Both 60 64 Proximal stent obstruction 70 63 Distal stent obstruction 30 37 Conclusions: Non malignant obstruction is a common though infrequently reported complication after placement of metal stents for esophageal cancer. No specific characteristic of the stent, or prior treatment seems to be related with the obstruction of the stent in both populations, NMO and TO. A better stent not causing this tissue reaction must be developed.