Delayed complications after esophageal stent placement for treatment of malignant esophageal obstructions and esophagorespiratory fistulas

PURPOSE: To evaluate delayed complications after esophageal expandable meta llic stent placement. MATERIALS AND METHODS: From April 1993 to December 1997, 90 expandable meta llic stents were placed in 82 consecutive patients with inoperable malignan t esophageal obstruction (n = 49) or malignant esophagorespiratory fistula (n = 33). Stents used included covered Gianturco-Rosch Z stents (n = 20), W allstents (covered, n = 31; uncovered, n = 13), and Ultraflex stents (cover ed, n = 8; uncovered, n = 10). Patients were followed prospectively and mon itored for delayed complications, defined as major (hemorrhage, tracheal co mpression, stent migration, perforation or fistula formation, granulomatous obstruction, tumor ingrowth and overgrowth, funnel phenomenon, and stent c overing disruption) or minor (reflux, chest pain, and food impaction). RESULTS: Mean survival was 4.5 months after stent placement (range, 3 weeks to 26 months). The overall incidence of delayed complications was 64.6%, w ith 17 patients (20.7%) experiencing more than one complication. The rates of delayed complications in patients with Z stents, Wallstents, and Ultrafl ex stents were 75.0%, 68.1%, and 44.4%, respectively (P <.05). Most complic ations were life-threatening and occurred more frequently when stents were placed in the proximal third of the esophagus, compared with more distally (P <.05). Thirteen patients (15.9%) died from complications directly relate d to stent placement. CONCLUSION: Esophageal stent placement for malignant obstruction or fistula is associated with a substantial incidence of delayed complications.