Self-expanding stents in oesophageal cancer

The overall prognosis of patients with inoperable oesophageal cancer is poor. Palliative therapy for dysphagia is the only therapeutic concern for most patients. Self-expandable metal stents have several advantages over the other palliative methods as they are easy to use, do not require predilation and give rapid relief from dysphagia and a low complication rate. The various models of self-expandable metal stents, different in the flexibility, size and presence or absence of a coverage, permit to adapt the stent to the features of the stricture and the presence of fistulae. Metal stents can be, however, difficult to remove and have high initial costs. Self-expandable plastic stents are easily retrievable and inexpensive and seem to achieve good palliative results in oesophageal neoplasms. There are, however, some limitations: significant stricture dilation is necessary before stent placement and angulated strictures are difficult to negotiate owing to the stiff and large delivery catheter. Furthermore, the complete coverage of the stent may represent a risk factor in early and late stent migration. The main therapeutic concern in patients with inoperable oesophageal cancer is palliation of dysphagia. Self-expandable metal stents are widely used because they are safer than conventional plastic stents, offer rapid relief from dysphagia and may seal off tracheo-oesophageal fistulae. Self-expanding metal stents, particularly when uncovered, are, however, associated with the disadvantage of tumour ingrowth. Self-expandable plastic stents are entirely covered and easy to reposition in case of migration and usually induce less inflammatory proliferation at their flanges when compared with metal stents. The major disadvantage of the current version of plastic stents is the large diameter and stiffness of the stent delivery system when compared with metal stents. Therefore, plastic stents are more difficult to place in patients with angulated strictures or with tumours located in the cervical oesophagus near the upper sphincter.