Esophageal Stent Placement - Indications and Procedure

Introduction

The esophagus is an important part of the digestive system. They help transport food from the mouth to the stomach. When the function of the esophagus is compromised due to strictures, malignancies, or other abnormalities, esophageal stent placement is a valuable therapeutic option. This article explains the types of stents, procedures, and indications of esophagus stent placement.

What Is Esophageal Stent Placement?

Esophageal stent placement is a surgical procedure performed to reduce the symptoms and complications related to various esophageal conditions. An esophageal stent is a hollow tube made of plastic or metal that is placed in the esophagus to keep the esophagus open, allowing food and liquids to easily pass through it. The stent is made up of a flexible mesh that gently expands automatically to keep the esophageal area open. However, it is not as flexible or wide as a normal esophagus so one should be cautious while eating or drinking certain foods and beverages that may cause blockage of the stent.

Many health conditions can partly block a portion of the esophagus, which makes it hard to swallow food or liquid. The medical term for difficulty swallowing is dysphagia. A person may also feel pain when they swallow or feel like food is stuck in their chest. Also, the food might come back up after they swallow. An esophageal stent will help reopen the blocked esophagus and ease symptoms.

What Are the Types of Esophageal Stents?

The two main esophagus stents are self-expanding metal stents (SEMS) and plastic stents.

• Self-Expanding Metal Stents (SEMS) - SEMS are made of nitinol, a nickel-titanium alloy. This material is very flexible and can expand and contract. These stents are positioned using a catheter and expand to their predetermined shape once placed. SEMS are known for their durability and ability to maintain patency for a long period.

• Plastic Stents - Plastic stents are generally made of polyethylene or other biocompatible materials. These stents are placed using endoscopy and dilated to achieve the desired width. Plastic stents are biodegradable and may need to be replaced periodically.

Who Is Indicated for Esophageal Stent Placement?

Esophageal stent placement is indicated for various health problems, with a narrowing or blockage in the esophagus hindering the normal passage of food and liquids. Generally, healthcare providers use esophageal stents to treat esophageal cancer, considered the most common reason.

However, the stents can also be used to treat the following conditions:

• Cancer in the upper part of the stomach.

• Narrowing of the esophagus due to pressure from the outside, such as in lung cancer or enlarged lymph nodes.

• Narrowing of the esophagus due to ulcer.

• Narrowing of the esophagus may occur after surgical procedures involving the esophagus.

• Narrowing of the esophagus due to cancer treatment

• Esophageal fistulas, an abnormal opening between the trachea and esophagus

• Perforations in the esophagus due to trauma.

How Is Esophageal Stent Placement Surgery Performed?

Procedure Before the Surgery:

Before surgery, careful patient assessment and preparation are necessary to ensure the safety and effectiveness of the procedure. A detailed medical history of the patient needs to be obtained to identify any comorbidities or factors that may influence the placement of the stent and the overall procedural approach. Also, any allergies to the stent material, especially metal stents, should be checked. A diagnostic procedure like an endoscopic examination assesses the extent and nature of the esophageal pathology. Radiological imaging, such as barium swallows or CT scans, is also conducted to check the anatomy and identify the location and characteristics of strictures or obstructions.

During the procedure:

The procedure is guided by endoscopy, in which the surgeon places a long, thin tube down the back of the patient's mouth and into the esophagus, allowing the physician to visualize the esophagus and accurately place the stent. A catheter containing the collapsed stent is passed through the mouth and guided to the target location.

Once the stent is positioned in its exact location, it is expanded to its predetermined diameter, providing support and maintaining the shape of the esophagus. Then, the surgeon removes the catheter and leaves the stent in its exact location. In some cases, fluoroscopy may be used to confirm the accurate placement of the stent. Additional dilation may be performed to correct the width of the stent and ensure adequate passage.

Post Procedure Care:

After esophageal stent placement, post-procedure care is important to monitor for complications and ensure optimal outcomes.

• Continuous monitoring of vital signs, including heart rate and blood pressure, is important during the post-procedural period.

• Patients may have discomfort after the procedure. Doctors may prescribe over-the-counter pain medicines. However, the pain usually does not last longer than a day or two.

• Patients may also be given other specific instructions, like initially restricting themselves to a liquid or soft diet and gradually advancing to a regular diet as tolerated.

• Patients are advised to follow up regularly. Periodic endoscopic evaluations may also be performed to assess the patency of the stent and address any issues that may arise over time.

• Potential complications, such as perforation or bleeding, will also be closely monitored.

What Are the Complications of Esophageal Stent Placement?

Esophageal stent placement is generally considered a safe and effective procedure, but some potential complications and considerations should be checked for:

• Stent migration can occur due to improper sizing, inadequate fixation, or dynamic changes in the esophagus. It may require repositioning or replacement.

• Stent obstruction can occur over time, where the stents may become obstructed by food particles or tumor growth. The obstructions should be cleared and replaced with the help of endoscopy.

• Perforation of the stent is a rare complication but requires immediate intervention to prevent serious complications.

• Some patients may experience discomfort and pain after stent placement, which is usually temporary.

• A temporary increase in dysphagia or reflux symptoms is noted in some people, which often improves over time.

Conclusion

Esophageal stent placement is important in managing various esophageal conditions, such as esophageal cancer. It provides relief from symptoms such as dysphagia and improves the quality of life for affected individuals. The procedure requires careful consideration of patient factors, appropriate stent selection, and diligent post-procedural care, which can reduce the complications after the surgery.