Is fluoroscopy necessary for oesophageal SEMS placement? A retrospective cohort study.

Abstract

Introduction: Self-expanding metal stents (SEMS) are widely used for the palliation of malignant esophageal conditions, including strictures, fistulas, and extrinsic compression. Placement may be guided by fluoroscopy (FC), direct endoscopy (EC), or both. However, few studies have directly compared the outcomes of these techniques.

Objective: To compare the safety and efficacy of SEMS placement under endoscopic versus fluoroscopic control in a real-world clinical setting.

Methods: We conducted a retrospective observational study of adult patients who underwent esophageal SEMS placement between January 2011 and December 2023. Patients were assigned to either the EC or FC group based on fluoroscopy availability. Outcomes included technical success, complication rates (early and late), and overall survival.

Results: A total of 103 patients were included (mean age 69.4 years; 79% male), with 43 receiving SEMS under EC and 60 under FC. The primary indication was malignant esophageal stricture (91.3%). Technical success was achieved in 97% of EC cases and 100% of FC cases. Early complications occurred in 53% of EC and 49% of FC patients (p = 0.70), including chest pain (40.7%), vomiting (22.3%), and stent migration (5.8%). Late complications occurred in 28% of EC and 31% of FC cases (p = 0.74), most commonly tumor overgrowth (14.6%) and stent migration (10.7%). Thirty-day mortality was 2.3% in the EC group and 0% in the FC group (p = 0.31). Median survival was 102 days (EC) vs. 113 days (FC) (p = 0.44).

Conclusions: SEMS placement under both endoscopic and fluoroscopic control is safe and effective, with no significant differences in complication rates, technical success, or survival. Endoscopic guidance may be a viable alternative to fluoroscopy in experienced hands, particularly in resource-limited settings.