Endoprosthetics for malignant esophageal disease

Currently used stents for malignant esophageal strictures include self-expanding metal stents (SEMS), self-expanding plastic stents (SEPS), and biodegradable stents. For the palliative treatment of malignant dysphagia, both SEMS and SEPS effectively provide rapid relief of dysphagia. SEMS are preferred over SEPS as randomized controlled trials have shown more technical difficulties and late migration with plastic stents. Despite specific characteristics of recently developed stents, recurrent dysphagia due to food impaction, stent migration, and both tumoral and nontumoral tissue overgrowths are common. Complication rates are probably also affected by stent “behavior” in the esophagus, with radial and axial forces being important determinants. The efficacy of stents with an antireflux valve for patients with distal esophageal cancer has not convincingly been proven. Concurrent treatment with chemotherapy and radiotherapy seems to be safe and effective, although biodegradable stents have shown disappointing results. It can be expected that removable stents will increasingly be used as bridge to surgery to maintain luminal patency during neoadjuvant treatment.