Aims Self-expanding metal stents (SEMS) are used in the treatment of various esophageal
conditions, such as strictures, perforations, and fistulas. They can be placed under
fluoroscopic guidance (FG), endoscopic guidance (EG), or a combination of both. However,
few studies directly compare these approaches. To assess and compare the safety and
feasibility of SEMS placement under FG and EG, based on the experience of our institution.
Methods This is a retrospective study of patients who underwent esophageal SEMS placement
between January 2011 and December 2023. Stents were placed either with fluoroscopic
support or under direct endoscopic visualization. Data were collected regarding immediate/early
complications (< 1 month post-insertion) and late complications (> 1 month post-insertion).
Results A total of 103 patients who underwent 114 SEMS placement procedures were included.
The main indications were malignant esophageal stricture (90%), tracheoesophageal
fistula (5.8%), and malignant extrinsic compression (2.9%). The majority of patients
were male (78.6%) with an average age of 69.4 years. SEMS placement was performed
under FG in 60 patients and EG in 43. Early complications occurred in 10.7% of patients
in the FG group and 11.7% in the EG group (p=0.36). The most common complications
were pain, vomiting, malposition/migration, bleeding, and dysphagia. Late complications
were recorded in 6.8% of patients in the FG group and 11.7% in the EG group (p=0.67),
including tumor invasion/growth, stent migration, esophageal fistulas, and food impaction
[1].
Conclusions SEMS placement under fluoroscopic and endoscopic guidance is safe and accurate, with
no statistically significant differences in complication rates between the two approaches.
Both techniques are effective in treating malignant esophageal strictures and other
conditions.
