Gastric Outlet Obstruction after Migration and Fracture of an Esophageal Stent: A Case Report

Abstract

Purpose: The most common delayed complications of esophageal stent placement are recurrent dysphagia due to tumor ingrowth or overgrowth (5-22%), obstruction due to food bolus impaction (13-21%), stent migration (6-11%), and esophago-respiratory fistula (4-9%). Isolated cases of small bowel obstruction and perforation after stent migration have been reported, as have several cases of stent fracture. To the best of our knowledge, this is the first report of a migrated and fractured stent causing gastric outlet obstruction. An 80 year old man with a diagnosis of locally advanced esophageal adenocarcinoma involving the distal esophagus and gastric cardia had a palliative Wilson-Cook esophageal Z-stent with anti-reflux valve placed endoscopically without complication. After completion of palliative chemotherapy and radiation treatment, he had a repeat upper endoscopy that showed a patent stent and no tumor ingrowth or overgrowth. He denied dysphagia at that time. Six months later, he was admitted to the hospital with complaints of progressive pleuritic chest discomfort, shortness of breath, and non-bloody post-prandial emesis. Chest and abdominal radiographs as well as a CT scan showed migration of the esophageal stent into the stomach and new massive bilateral pleural effusions. Upper endoscopy was performed which showed a fractured esophageal stent in the antrum, likely crossing the pylorus into the bulb. The stent was not removed endoscopically. The patient elected for palliative measures alone, declining endoscopic or surgical removal of the stent. He was discharged to home hospice care.