Aims
Malignant esophageal strictures are frequently managed using self-expanding metal stents (SEMS). Stent-related adverse events, especially stent dysfunction, pose a significant challenge and often require reintervention. The aim of this study was to determine predictors of stent dysfunction in malignant esophageal strictures.
Methods
This multicenter, retrospective study included patients with malignant esophageal strictures who were treated with SEMS at three university hospitals between January 2014 and December 2023. The clinical endpoint was the occurrence of stent dysfunction, defined as impairment of lumen patency due to ingrowth, overgrowth, bolus, or dislocation. Patient characteristics, stricture features, and procedural factors were analyzed.
Results
In total, 187 patients were included in the study. The mean age was 67 ± 11 years, and 78% of the patients were male. The overall complication rate was 43%, stent dysfunction occurred in 32% of patients.
Univariable logistic regression analysis showed that patients over 65 years (OR 2,2; 95% CI 1,2–4,4; p = 0,016) or with cardiac comorbidity (OR 2,3; 95% CI 1,2–4,4; p = 0,008) experienced stent dysfunction significantly more often.
Stents placed at the gastroesophageal (GE) junction (OR 2,1; 95% CI 1,1–4,0; p = 0,019) or an esophagojejunal anastomosis (OR 5,8; 95% CI 1,1–31,0; p = 0,039) were more prone to dysfunction.
The risk of stent dysfunction was higher with a stricture diameter ≥9 mm (OR 2,2; 95% CI 1,2–4,2; p = 0,012), and also when fully covered (OR 2,4; 95% CI 1,3–4,5; p = 0,008) or small-diameter SEMS ≤22mm (OR 2,3; 95% CI 1,1–4,8; p = 0,033) were used.
In multivariable analysis, age ≥65 years (OR 2,4; 95% CI 1,1–5,2; p = 0,023), the presence of an esophagojejunostomy (OR 9,5; 95% CI 1,6–57,9; p = 0,014), a stricture diameter ≥9 mm (OR 2,2; 95% CI 1,1–4,5; p = 0,024), and the use of a fully covered SEMS (OR 2,5; 95% CI 1,2–4,9; p = 0,011) were significantly associated with an increased risk of stent dysfunction.
|
Factors |
Univariable Analysis |
Multivariable Analysis |
||
|
OR (95% CI) |
p-value |
OR (95% CI) |
p-value |
|
|
Age ≥ 65 Years |
2,2 (1,2–4,4) |
0,016 |
2,4 (1,1–5,2) |
0,023 |
|
Female Sex |
0,7 (0,3-1,5) |
0,397 |
|
|
|
Cardiac Comorbidity |
2,3 (1,2–4,4) |
0,008 |
|
|
|
Pulmonary Comorbidity |
0,8 (0,4-1,8) |
0,637 |
|
|
|
Hepatic Comorbidity |
2,3 (0,6-8,3) |
0,208 |
|
|
|
Renal Comorbidity |
1,4 (0,5-3,6) |
0,495 |
|
|
|
Dysphagia Score > 1 |
0,7 (0,3-1,3) |
0,180 |
|
|
|
Adenocarcinoma |
1,8 (1,0-3,5) |
0,057 |
|
|
|
Upper Esophagus |
0,9 (0,3-2,5) |
0,875 |
|
|
|
Middle Esophagus |
0,6 (0,3-1,3) |
0,196 |
|
|
|
Lower Esophagus |
1,6 (0,9-3,2) |
0,129 |
|
|
|
GE Junction |
2,1 (1,1-4,0) |
0,019 |
|
|
|
Esophagogastrostomy |
0,5 (0,1-2,5) |
0,426 |
|
|
|
Esophagojejunostomy |
5,8 (1,1-31,0) |
0,039 |
9,5 (1,6–57,9) |
0,014 |
|
Stricture Length ≤ 20mm |
0,8 (0,3-2,4) |
0,682 |
|
|
|
Stricture Diameter ≥ 9mm |
2,2 (1,2-4,2) |
0,012 |
2,2 (1,1–4,5) |
0,024 |
|
Fully Covered SEMS |
2,4 (1,3-4,5) |
0,008 |
2,5 (1,2–4,9) |
0,011 |
|
Stent Length ≤ 110 mm |
1,6 (0,8-3,0) |
0,181 |
|
|
|
Stent Diameter ≤ 22mm |
2,3 (1,1–4,8) |
0,033 |
|
|
Conclusions
A stricture diameter ≥9 mm, the use of fully covered SEMS, the presence of an esophagojejunostomy, and older age were identified as independent predictors of stent dysfunction in malignant esophageal strictures. These factors should guide stent choice and individualized therapy.