Possible Complications

1. Initial technical failures and procedure-related complications are extremely rare.  Reports in the literature describe successful stent placement in nearly 100% of patients.  Only 1-2% of stents fail to expand enough for the patient to maintain adequate nutrition.  The improvement of dysphagia in patients is described as good or very good by most reports.  Following stent placement, 78-80% of patients can eat a normal diet, 13-20% can eat soft foods, and 0-7% are restricted to liquids only.  Most patients die without recurrence of debilitating dysphagia.  One study comparing the results of various methods of palliation found that dysphagia was completely relieved in 78/140 (56%) treated with radiation therapy, 31/63 (49%) treated with chemotherapy, and 53/66 (81%) treated with stent insertion.  Furthermore, response to stent placement was immediate, while full effect from the other modalities took at least 9-10 weeks.
   
   

2. Late complications of self-expanding metal stent placement include stent migration (0-25%), esophageal perforation (0-2%), esophagorespiratory fistula (0-5%), food impaction (0-14%), tumor ingrowth (0-36%), tumor overgrowth (3-10%), severe hemorrhage (0-6%), benign stricture at stent end (0-6%), GE reflux (0-7%), and intractable chest pain requiring narcotic analgesia (0-7%).  Migration occurs more frequently with covered stents, especially those that sit astride the GE junction with the distal end free in the gastric lumen, and with stents used for benign strictures.  Tumor ingrowth occurs primarily through noncovered metal stents; however, most patients will die of their cancer before the stent can become occluded.  Tumor ingrowth can be managed successfully with endoscopic laser coagulation or by placing a second stent inside the first.  Severe bleeding is more frequent with the larger-sized Gianturco-type stents, especially in patients who have received radiation therapy after stent placement.  Severe chest discomfort requiring narcotics for pain control is seen almost exclusively after placement of Gianturco-type stents.  Stent related mortality is reported to be between 0% and 6%.  Placement failure and complication rates for self-expanding metal stents compare favorably with those reported for nonexpandable plastic tube stents that have an insertion failure rate of 10% and complication rate of 36-40%.