New insights of stent placements for malignant upper gastrointestinal cancers

Palliative care for patients with incurable esophageal cancer aims to alleviate symptoms to improve their quality of life. A commonly method involves the placement of self-expanding metal stents to enhance food passage. While this approach is generally effective, complications may arise, often necessitating additional endoscopic interventions and potentially impacting patients' quality of life. This thesis seeks to offer new insights into stent placement as a palliative treatment and provide an understanding of complications post-stent placement.

The thesis commences with a comprehensive overview of the literature on palliation of dysphagia in patients with esophageal cancer. For patients with a life expectancy fewer than three months, esophageal stent placement is recommended due to its rapid relief of dysphagia. Although brachytherapy has traditionally been the recommended treatment for patients with a life expectancy of over three months, recent data suggest that external radiotherapy could be an effective and safe alternative.

New oncological treatments and improvements in patient survival might influence the response and outcome of self-expanding metal stent placement. These changes are analyzed in a retrospective study spanning 23 years. Despite the introduction of new esophageal stent designs, the number of patients experiencing renewed dysphagia after stent placement did not decrease. However, the incidence of severe complications decreased. One of the most disruptive symptoms in cancer patients is pain. Sixty percent of patients experienced significant pain immediately after esophageal stent placement, and over 30% still required opioids two weeks after the procedure. There is no difference between fully covered and partially covered esophageal stents concerning complications and recurrence of dysphagia.

The thesis closed with the clinical outcomes of placing duodenal stents for malignant conditions over a 20-year period. Over time, total survival decreased, and more than half of the patients experienced symptom recurrence after duodenal stent placement.