Abstract
Background Self-expandable metal stents (SEMSs) are effective for improving dysphagia in patients
with incurable esophageal cancer but are also associated with recurrent dysphagia
and adverse events. In the past decades, new SEMSs have been introduced, but also
patients’ risk profiles have altered. It is unknown if these changes have affected
SEMS outcomes.
Methods This retrospective cohort study was conducted in a tertiary referral center in the
Netherlands. Patients who underwent palliative esophageal SEMS placement for malignant
dysphagia between 1994 and 2017 were included. The primary outcome was to assess shifts
over time with respect to recurrent dysphagia and adverse events after SEMS placement.
Results 997 patients who underwent SEMS placement were included. Recurrent dysphagia occurred
in 309 patients (31 %) and remained stable, although with a trend towards an increase
over time (hazard ratio [HR] 1.02 per 1-year increase; P = 0.05). Migration rate significantly increased over time (HR 1.04 per 1-year increase;
P = 0.01). SEMS-related complications occurred in 461 patients (46.2 %), with 207 (20.7 %)
major and 336 (33.7 %) minor complications. Prior chemoradiotherapy was significantly
associated with major complications (HR 1.69; P < 0.001). Pain was the most common adverse event and showed a significant increase
over time (P < 0.01). Factors associated with pain were prior chemoradiotherapy, absence of a
fistula, axial and radial forces, and squamous cell carcinoma.
Conclusions Despite the introduction of novel esophageal SEMS designs, recurrent dysphagia has
not declined over the years. Stent-related complications have increased in recent
years, which seems to be mainly associated with more frequent use of chemoradiotherapy
prior to SEMS placement.
