Sa1568 Immediate, Early and Late Complications in Esophageal SEMS

Abstract

The various indications for placement of esophageal self-expandable metal stent (SEMS) include fistulas, tears, perforations, and stenoses; both of malignant and benign etiology. International series describe a complication rate of 7 - 70%, including both minor and major events. Evaluate the immediate, early, and late complications of esophageal SEMS. From June 1996 to December 2010, 157 esophageal SEMS were placed. Complications were evaluated during the immediacy of placement (less than 24 hours), at an established early period (1 to 30 days), and throughout a late period (more than 30 days). Follow-up was possible in 67% of patients. Mean patient age was 66.4 years, with a male predominance of 76.7%. Indication for SEMS placement was of malignant etiology in 75.7%. Mean length of stenosis was 7.5cm. Forty-four percent of patients developed minor complications. Immediate complications were seen in 3.8%, being the most frequent: airway aspiration - 2 patients (50%), and proximal migration - 1 patient (25%). Early complications presented in 21.2%: proximal migration - 6 (27.3%), distal migration - 5 (22.7%), and decubitus ulceration - 5 (22.7%), among others. Late complications occurred in 44.2%: tumor overgrowth - 14 (30.4%), severe pain - 10 (21.7%), distal migration - 10 (21.7%), and food impaction - 3 (6.5%), were the most prevalent. No major complications were seen, associated with stent placement; and no patients died due to complications related to the procedure. Mean patient survival was 5.2 months. The incidence of immediate, early, and late complications, seen in our patients, is similar to what is described in larger series. We therefore concur that SEMS continue to be an adequate treatment option for the management of esophageal stenoses, fistulas, or perforations; both of benign or malignant etiology.