Predictors of dysfunction in fully versus partially covered self-expanding metal stents for malignant esophageal strictures: a 10-year multicenter study.

Abstract

Background: Esophageal self-expanding metal stents (SEMS) effectively restore oral intake in malignant obstruction, yet stent dysfunction remains a frequent clinical challenge. We aimed to identify and compare predictors of stent dysfunction in fully versus partially covered self-expanding metal stents (fcSEMS vs. pcSEMS).

Methods: This multicenter retrospective cohort included patients undergoing SEMS placement for malignant esophageal strictures between 2014 and 2023. Stent dysfunction comprised migration, tumor overgrowth, or food bolus impaction. Patients with benign or anastomotic strictures, prior ablative therapy, or uncovered SEMS were excluded. Cumulative incidence and Fine-Gray subdistribution hazard models were used, treating death as a competing event. Interaction terms assessed effect modification by stent type.

Results: Of 249 screened patients, 188 were included (mean age 68.0 ± 10.7 years; 78.7% male; 92 pcSEMS and 96 fcSEMS); technical success was 97.3%. Dysfunction occurred in 29.8% and was more frequent with fcSEMS than pcSEMS (36.5% vs. 22.8%; p = 0.04), primarily due to migration (31.3% vs. 10.9%; p < 0.01). Within 12 months, 37 patients (19.7%) died before dysfunction and were treated as competing events. In adjusted Fine-Gray models, strictures caused by other malignancies (non-squamous/non-adenocarcinoma) were strongly associated with dysfunction in the fcSEMS group (sHR 6.53; 95% CI 2.51-16.98; p < 0.01), with significant effect modification by stent type (sHR interaction 14.1; 95% CI 2.08-95.8; p < 0.01). Larger stricture diameter independently predicted dysfunction with fcSEMS (sHR per mm 1.21; 95% CI 1.01-1.45; p = 0.04), while lower esophageal location showed a borderline association (sHR 2.33; 95% CI 0.89-6.07; p = 0.08). Adverse-event rates were comparable (35.9% vs. 43.8%; p = 0.27).

Conclusion: Patterns of stent dysfunction differed between fcSEMS and pcSEMS. Tumor etiology and stricture anatomy may guide risk-stratified stent selection and help reduce reinterventions.

Trial registration: Not applicable.