7146 Expulsion of an esophageal metal stent by foreceful emesis.

Abstract

A 39-year white male was diagnosed with esophageal cancer with metastases after presenting with dysphagia. A large, bulky exophytic esophageal tumor extended 29 cm to 40 cm from the incisors, ending at the GE junction. Biopsies revealed invasive poorly differentiated carcinoma. While receiving palliative chemotherapy, he developed profound dysphagia for liquids and solids. A 15 cm long, 18 mm diameter coated Microvasive Ultraflex expandable metal stent was placed under fluoroscopic guidance. X-rays confirmed the correct positioning of the stent. Immediately after the stent placement, the patient did well and was discharged home. 36 hours later he became nauseous and developed severe vomiting. During the vomiting the metal stent was regurgitated and expelled from the esophagus. The patient was readmitted and treated with anti-emetics for 48 hours. A 12 cm long 23 mm diameter coated Microvasive Ultraflex expandable metal stent was inserted and he has tolerated this stent well. To our knowledge, this is the first reported case of spontaneous expulsion of an expandable metal stent by vomiting. Distal and proximal migration of esophageal stents has been well reported. Distal migration usually occurs when the stent lies across the GE junction and proximal migration when the stent lies in the region of the cricopharyngeus. Dislodgement by severe emesis must be considered a rare complication. Nevertheless, this complication raises the question of whether anti-emetices should be given prophylactically until the stent has epithelialized to prevent expulsion.