Nonmalignant obstruction is a common problem with metal stents in the treatment of esophageal cancer

Background: The use of metal stents for the treatment of dysphagia due to e sophageal melignancy is an important advance because of ease of delivery an d their self-expandable property. obstruction due to tumor overgrowth is a recognized complication, but nonmalignant obstruction in patients with meta l stents is rarely reported. Methods: Database records of patients who had esophageal cancer and underwe nt metal stent insertion were reviewed. Results: A total of 116 patients were seen between October 1993 and October 1997. Four types of metal stents had been used (Ultraflex, Z Stent, Wallst ent, and Esophacoil). Detailed follow-up Information was available for 81 p atients, who constitute the study sample. Forty-nine (60%) stent obstructio ns were reported, 26 of the 49 (53%) were due to tumor overgrowth and 23 (4 7%) were not associated with malignancy. Histologic analysis of the nonmali gnant obstructing tissue showed granulation tissue (56%), reactive hyperpla sia (22%) and fibrosis (22%). Conclusions: Nonmalignant obstruction is a common although infrequently rep orted complication after placement of metal stents for esophageal cancer. T he tissue response of the esophageal mucosa occurred with all 4 types of st ents used. No specific characteristic of the stent or prior treatment seems to be related to obstruction of the stent in patients with either nonmalig nant obstruction or tumor overgrowth.