Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Manon C. W. Spaander; Ruben D. van der Bogt; Todd H. Baron; David Albers; Daniel Blero; Antonella de Ceglie; Massimo Conio; László Czakó; Simon Everett; Juan-Carlos Garcia-Pagán; Angels Ginès; Manol Jovani; Alessandro Repici; Eduardo Rodrigues-Pinto; Peter D. Siersema; Lorenzo Fuccio; Jeanin E. van Hooft

doi:10.1055/a-1475-0063

Endoscopy, Table of Contents

Endoscopy 2021; 53(07): 751-762
DOI: 10.1055/a-1475-0063

Guideline

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Authors

Manon C. W. Spaander

¹Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Ruben D. van der Bogt

¹Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Todd H. Baron

²Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
David Albers

³Department of Internal Medicine and Gastroenterology, Elisabeth-Krankenhaus Academic Hospital, University of Duisburg-Essen, Essen, Germany
Daniel Blero

⁴Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, ULB (Free University of Brussels), Brussels, Belgium
Antonella de Ceglie

⁵Department of Gastroenterology, Ospedale Civile di Sanremo, Sanremo (IM), Italy
Massimo Conio

⁶Department of Gastroenterology, Ospedale Santa Corona, Pietra Ligure (SV), Italy
László Czakó

⁷First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
Simon Everett

⁸Department of Gastroenterology and Hepatology, Leeds Teaching Hospital NHS Trust, Leeds, UK
Juan-Carlos Garcia-Pagán

⁹Barcelona Hepatic Hemodynamic Laboratory, Liver Unit – Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver) – Hospital Clinic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain
Angels Ginès

¹⁰Gastroenterology Department, Hospital Clinic of Barcelona, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain
Manol Jovani

¹¹Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
Alessandro Repici

¹²Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy

¹³Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
Eduardo Rodrigues-Pinto

¹⁴Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
Peter D. Siersema

¹⁵Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
Lorenzo Fuccio

¹⁶Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
Jeanin E. van Hooft

¹⁷Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands

Abstract

Main recommendations

Malignant disease

1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass.

Strong recommendation, high quality evidence.

2 ESGE recommends brachytherapy as a valid alternative, alone or in addition to stenting, in esophageal cancer patients with malignant dysphagia and expected longer life expectancy.

Strong recommendation, high quality evidence.

3 ESGE recommends esophageal SEMS placement for sealing malignant tracheoesophageal or bronchoesophageal fistulas.

Strong recommendation, low quality evidence.

4 ESGE does not recommend SEMS placement as a bridge to surgery or before preoperative chemoradiotherapy because it is associated with a high incidence of adverse events. Other options such as feeding tube placement are preferable.

Strong recommendation, low quality evidence.

Benign disease

5 ESGE recommends against the use of SEMSs as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and their cost.

Strong recommendation, low quality evidence.

6 ESGE suggests consideration of temporary placement of self-expandable stents for refractory benign esophageal strictures.

Weak recommendation, moderate quality evidence.

7 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures because of their very low risk of embedment and ease of removability.

Weak recommendation, low quality evidence.

8 ESGE recommends the stent-in-stent technique to remove partially covered SEMSs that are embedded in the esophageal wall.

Strong recommendation, low quality evidence.

9 ESGE recommends that temporary stent placement can be considered for the treatment of leaks, fistulas, and perforations. No specific type of stent can be recommended, and the duration of stenting should be individualized.

Strong recommendation, low quality of evidence.

10 ESGE recommends considering placement of a fully covered large-diameter SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive bleeding.

Strong recommendation, moderate quality evidence.

Full Text

References

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