To anchor or not to anchor self-expanding metal stents in malignant esophageal disease: Is this still a question?

Fully or partially covered self-expandable metal stents (SEMSs) are one of the main pillars for the palliative therapy of esophageal cancer [1]. Furthermore, SEMSs are also useful to treat a myriad of esophageal conditions, including benign stenosis, anastomotic insufficiency after gastroesophageal operations, and various types of leaks, perforations, and fistulae [2] [3] [4]. When Symonds inserted the first stent for the palliation of esophageal cancer, it was a rudimentary tube made of rubber originating from the tropical tree gutta percha [5]. Although these rubber stents improved the patient’s ability to ingest some nutrients, mainly liquids and semi-liquids, they soon became dislodged and migrated distally. Thus, the advent of the fully or partially covered SEMS was a major breakthrough in the therapy and palliation of esophageal diseases [1] [6] [7]. Nonetheless, despite improvements in design, with proximal or mid-stent tulips, various shapes and diameters, and the presence of outward, expansive radial forces, these SEMSs still have high migration rates [2] [6] [7] [8] [9]. Therefore, experts all over the world have proposed additional methods to prevent stent migration, including strings, through- and over-the-scope clips (OTSCs), and suturing devices [3] [4] [6] [10] [11] [12].