Malignant Esophageal Strictures Research Articles

Management of inoperable malignant oesophageal strictures with fully covered WallFlex® stent: A multicentre prospective study

BackgroundThe majority of currently available oesophageal metal stents are partially covered to reduce migration risk. Preliminary experiences with fully covered stents seem to indicate an increased risk of migration in patients treated for malignant dysphagia. The aim of our study was to determine, in this setting, the safety and efficacy of a new, recently introduced stent with anti-migration proprieties. MethodsWe designed a prospective, multicentre, non-randomized, follow-up study in nine tertiary referral centres. Eighty-two patients with dysphagia due to inoperable or metastatic oesophageal cancer were included. In all of them the fully covered WallFlex® stent was placed. Main outcome measurements included functional outcome, recurrent dysphagia, complications, and mortality. ResultsDysphagia score improved from a median of 3, before stenting, to 1 at 4 weeks after stent placement (P<0.001). Perforation occurred in 1 patient after 39 days, while bleeding was reported in 3. In total, 19 patients (23.1%) developed recurrent dysphagia because of stent migration (N=10, 12.2%), tissue overgrowth (N=7; 8.5%), and food impaction (N=2; 2.4%). ConclusionsPlacement of the fully covered WallFlex® stent resulted in safe and effective palliation of malignant dysphagia, with migration and tissue overgrowth rates comparable to previously reported data on partially covered stents.

Establishing a rabbit model of malignant esophagostenosis using the endoscopic implantation technique for studies on stent innovation

BackgroundStents are recommended in patients with dysphagia caused by esophageal stricture, but an ideal stent does not currently exist. Thus, studies on new esophageal stents are necessary, and suitable animal models are desperately needed for these studies. The aim of this study was to establish a model of malignant esophageal stricture in rabbit for studies on stent innovation.MethodsA total of 38 New Zealand white rabbits were used in this study. Using the endoscopic submucosal injection technique, VX2 fragments were inoculated into the submucosal layer of the rabbit thoracic esophagus, and an endoscopic follow-up was subsequently performed to observe the tumor development and progression. The self-expandable metal stents were randomly deployed in rabbits with severe esophageal stricture to investigate the safety and feasibility of the animal models for stenting.ResultsAn endoscopic implantation procedure for VX2 tumors was completed in 34/38 rabbits, and tumor development was confirmed in 30/34 animals. The success rate of the endoscopic implantation and tumor development were 89.4% (95% CI, 79.6% to 99.2%) and 88.2% (95% CI, 76.9% to 99.5%) respectively. During the endoscopic follow-up period, severe esophageal stricture occurred in 22/30 rabbits with a rate of 73.3% (95% CI, 57.5% to 89.1%), and 12/22 models received stent placement. During and after stent implantation, no severe stent-related complication or mortality occurred in the animal models. The rabbits that received stent placement survived longer than those without stent implantation (the mean survival time: 53.9 days versus 40.3 days, P = 0.016).ConclusionThe endoscopic method is a safe and effective method for establishing a malignant esophagostenosis model in rabbits. This model can simulate the human body environment for stent deployment and is an excellent tool for the study of stent innovation for the treatment of esophageal cancer.

Intratumoural injection of absolute alcohol in carcinoma of gastroesophageal junction for palliation of dysphagia.

Background:Ethanol-induced tumour necrosis (ETN) is a simple, readily available palliative treatment for patients with inoperable carcinoma of the oesophagus with poor performance status. In India, capital outlay needed for stenting or laser therapy is out of reach. Hence, we took up this study to calculate the effect of intratumoral injection of absolute alcohol in palliation of dysphagia due to carcinoma of the oesophagogastric junction and to monitor the improvement in quality of life (QOL).Methods:A total of 16 patients with a mean age of 56.2 ± 7.5 years with dysphagia due to unresectable malignant oesophageal strictures involving the oesophagogastric junction were included in the study. Six to ten cubic centimetres of absolute alcohol in 1 cc aliquots was injected circumferentially into the tumour at the point of luminal obstruction using disposable sclerosing needles (23G). During each follow up dysphagia grade, QOL score and complications, if any, were noted.Results:The mean alcohol injected per session was 6.9 ± 1.8 cc. The mean dysphagia grade improved from 5.5 ± 0.5 to 2.5 ± 1.1 before and after alcohol injection, respectively (p < 0.001). The time taken for recurrence of dysphagia ranged from 14 to 80 days with a median of 28 days. The mean QOL score assessed by modified EORTC questionnaire improved from a mean of 63.6 ± 6.9 to 92.6 ± 13.9 (p < 0.001). The dysphagia free survival ranged from 23 to 175 days with a mean of 71.2 days. Complications included oesophageal perforation in one patient and death in one patient.Conclusion:The endoscopic intratumoral injection of absolute alcohol significantly improves dysphagia and QOL. It is inexpensive and easy to perform.

Palliation of Esophageal Cancer with a Double-layered Covered Nitinol Stent: Long-term Outcomes and Predictors of Stent Migration and Patient Survival

To evaluate the long-term clinical outcomes and the negative predictors after the deployment of double-layered stents in malignant esophageal strictures. This is a single-center study of patients who received a double-layered covered stent for the palliation of dysphagia due to malignant esophageal strictures in a 3-year period. 56 patients fulfilled the inclusion criteria. The study's primary end points were technical success, dysphagia improvement, stent migration, and complication rates; secondary end points were the stent's primary patency and overall survival. Cox regression analysis was used to adjust for confounding variables and to identify predictors of survival outcomes. Technical success was 95%. Median dysphagia score improved significantly after stenting (p < 0.0001). Stent migration rate was 7.1% and occurred exclusively in the group of patients who received chemoradiotherapy (p < 0.01). The median stent patency was 87 days (range 5-444 days). Dysphagia reoccurred in 39.3% and was successfully managed with restenting in 98.2%. The median survival was 127 days (range 15-1480 days). Chemoradiotherapy and baseline histology did not influence survival outcomes. Survival was adversely affected by metastases (p = 0.005) and poor oral intake (p = 0.048). Patient survival was improved by repeat stenting in case of tissue overgrowth (p = 0.06). The device is safe and effective for the treatment of patients with dysphagia due to esophageal cancer. Migration rate is zero for patients who do not receive chemoradiotherapy. Reintervention when required is a positive survival predictor.

Endoscopic Removal of an Esophageal Stent After Diffuse Hyperplastic Tissue Ingrowth

Endoscopic placement of esophageal Self-Expandable Metal Stents (SEMS) is a therapeutic option for post-surgical esophageal leaks. Partially covered SEMS are mainly designed for malignant esophageal strictures, but are used off-label to close post-surgical leaks due to their lower migration rate than fully covered SEMS, and better adherence to the esophageal wall. Partially covered esophageal SEMS can achieve post-surgical fistula healing, but their removal is difficult due to tissue ingrowth through the uncovered part. A challenging case of a difficult removal of a partially covered esophageal SEMS (remove the indefinite article) is (below) presented.

The role of endoscopy in the evaluation and management of dysphagia

The role of endoscopy in the evaluation and management of dysphagia

Enteral stents: from esophagus to colon

Because of significant advances in endoscopic techniques and the development of high-quality stents, endoscopic enteral stent placement is increasingly being performed for the management of malignant GI obstruction. Palliative stenting is now routinely performed for malignant esophageal, gastric, duodenal, and colon obstruction. In addition to palliative indications, preoperative stenting in the colon may be performed as a bridge to surgery to achieve immediate decompression and convert an emergent surgery into an elective, 1-stage procedure.The realm of enteral stenting has recently expanded to include management of benign conditions such as leaks, fistulas, and benign strictures in the GI tract. Further research is required to study the use of enteral stents in benign conditions and to adequately compare endoscopic stent placement with surgical intervention. Promising new technologies such as biodegradable stents and drug-eluting stents also require further investigation. With continued innovation in endoscopic techniques and stenting devices, the field of enteral stenting is likely to expand further, with an increase in indications and improvement in outcomes.

Stent Type Used Does Not Impact Complication Rate or Placement Time but Can Decrease Treatment Cost for Benign and Malignant Esophageal Lesions

Purpose: Esophageal obstruction occurs from either intrinsic or extrinsic etiologies. Intrinsic causes are more common and largely due to malignancy. The majority of esophageal cancer patients are not resection candidates, requiring palliative stent placement. SEMS (self-expanding metal stents) are thought to be preferable to SEPS (self-expanding plastic stents) for palliation of malignant disease due to perceived decreased technical difficulties and stent migration rates. Data using SEPS in benign disease are mixed and report success rates between 17-95%. In addition, SEPS are not routinely recommended due to complications. The aim of the study was to retrospectively compare safety, efficacy, clinical outcomes and placement ease of SEMS and SEPS in benign or malignant esophageal stenosis. Methods: All patients at UFCOM-Jacksonville endoscopy laboratory having EGD with stent placement for benign or malignant esophageal stenosis between January 2005 and April 2012 were eligible for study. Patients without stent placement at the completion of EGD were excluded. Data collected included patient demographics, procedure time, stent cost and clinical outcomes (technical success of stent placement, procedure-related complications, need for subsequent re-intervention, length of hospital stay and mortality). Results: Forty-three patients underwent stent placement for either benign or malignant disease during the study period. SEMS were placed in 30 patients (25 male, mean age 59.6 yrs old) and SEPS were used in 13 patients (10 male, mean age 61.7 yrs old). Placement outcome of SEPS compared to SEMS did not differ statistically. Complication rate in the SEPS group was 23.1% compared with 25.2% in the SEMS group. Stent migration was the most frequent complication, occurring in 66.7% in the SEPS group compared with 57.1% in the SEMS group. In-hospital mortality was also similar: 7.7% (SEPS) compared with 6.7% (SEMS). Procedure time, need for re-intervention, survival after procedure, length of hospital stay and time to first complication were also not significantly different between SEPS and SEMS groups. Interestingly, metal stents were more expensive than plastic stents with an institution cost difference of approximately $205/stent and even higher patient costs. Conclusion: SEPS and SEMS placement produced similar outcomes for either benign or malignant esophageal occlusion. SEPS are less costly than SEMS and it may be more practical to initially use SEPS due to this factor. If all patients who received SEMS had SEPS placed instead, a significant cost reduction would be realized for this patient cohort.

Clinical application of iodine-eluting stent in patients with advanced esophageal cancer

The aim of the present study was to compare the clinical effectiveness of an iodine-eluting stent with a conventional stent in patients with advanced esophageal cancer. Patients with malignant esophageal cancer were randomly assigned to receive a conventional stent (group A) or an iodine-eluting stent (group B). Following implantation, the relief from dysphagia, survival time, routine blood tests, thyroid function examination and complications were compared in the two groups. Groups A and B consisted of 36 and 31 patients, respectively. The mean value that the dysphagia score decreased by was significantly lower in group A (0.83) compared with group B (1.65). The median survival time was longer in group B compared with group A (P=0.0022). No significant differences were observed in the severe complications between the two groups (P=0.084). The iodine-eluting esophageal stent is a relatively safe, feasible and effective treatment for malignant esophageal strictures.

Su1503 Dysphagia Relief and Adverse Events Associated With Fully Covered Evolution® Esophageal Stents in Malignant Esophageal Strictures: Does Size Matter?

covered 20-mm SEMS which combines bilateral flared ends and three rows of anchoring flaps on the stent body for the prevention of migration. Aim: To evaluate the clinical efficacy and safety of the HANARO-Utrecht stent for the palliation of malignant dysphagia. Methods: Consecutive patients who underwent HANARO-Utrecht stent placement for palliation of malignant dysphagia in four centers from June 2011 until October 2012 were included. Patients were contacted after 2 weeks and monthly thereafter until death. Technical success, recurrent dysphagia, migration, survival and complications were evaluated. Results: Forty patients (29 men (72.5%), mean age 68 11 years) were included. Malignant dysphagia was caused by esophageal cancer (n 32), malignant extrinsic compression (n 5), tumor recurrence after esophagectomy (n 2) and gastric cancer (n 1). Four patients (10%) had an esophageal-respiratory fistula and 26 patients (65%) had undergone previous radiation and/or chemotherapy. Stent placement was technically successful in 38 patients (95%), in 1 patient the stent collapsed during repositioning and a second stent was placed through the stent and in 1 patient the stent was placed more distally than intended despite repositioning. Thirty-four patients (85%) remained dysphagia free during followup (median 59 days, range 2-397), while 6 patients (17%) had recurrent dysphagia after a median of 39 days (range 9-48), due to stent migration (n 5) and tissue overgrowth (n 1). In 4 of these patients, the stent had partially migrated and could be repositioned endoscopically, while in 2 patients a new stent was placed. One patient presented with recurrent partial migration after 59 days, for which repeat repositioning was performed. Fourteen patients are still alive after a median of 59 days (range 15-397) and 26 patients died after a median of 58 days (range 2-210), due to disease progression (n 20), complicated pneumonia (n 3), cardiac disease (n 1), euthanasia (n 1) and acute hypoxemia due to tumor ingrowth in the trachea (n 1). In total, 24 major complications occurred in 18 patients (47%), including severe pain (n 7), severe nausea and/or vomiting (n 6), bleeding (n 4), aspiration pneumonia (n 4), fistula formation (n 2) and tracheal compression (n 1). Conclusion: Despite the specific anti-migration features of the HANARO-Utrecht stent, migration was the main cause of recurrent dysphagia. We also observed a relatively high complication rate, especially severe pain, nausea and vomiting after placement, further improvements in stent design are needed.

Su1502 A New Fully Covered Metal Stent (Hanaro-Utrecht Stent) for the Treatment of Malignant Esophageal Strictures: a Prospective Follow-up Study

Placement of self-expandable metal stents (SEMS) provides effective palliation in patients with malignant dysphagia. Although fully covered SEMS are increasingly used to prevent tissue ingrowth, they are prone to migrate. To reduce migration risk, we developed the HANARO-Utrecht stent, a new fully covered 20-mm SEMS which combines bilateral flared ends and three rows of anchoring flaps on the stent body for the prevention of migration.

Covered Self-Expandable Metallic Stents Could be Used Successfully in the Palliation of Malignant Cervical Esophageal Strictures

To present the authors' preliminary experience with covered self-expandable metallic stents in the palliation of malignant cervical esophageal strictures. Covered self-expandable metallic stents were placed into the cervical esophagus of 6 patients with malignant cervical esophageal strictures under fluoroscopic guidance. Stent placement was technically successful in all patients, and the mean dysphagia score decreased from 3.3 to 0.5 according to the Ogilvie Dysphagia Scoring. Two patients complained of chest pain, which lasted for 24 to 48 hours. Foreign body sensation disappeared spontaneously within a week in all patients, but one. Migration, dysphagia, or obstruction was not observed in any of the patients during the follow-up period (47 d to 8 mo). According to our limited number of cases, placement of covered self-expandable metallic stents into the cervical esophagus can be performed safely, and significant improvement of dysphagia scores and life quality of patients can be obtained instantly after the procedure.

Update on Foreign Bodies in the Esophagus: Diagnosis and Management

Foreign body impaction in the esophagus is an important emergency that carries significant morbidity and potential mortality. The most common cause of esophageal foreign body obstruction in adults is meat bolus impaction above a pre-existing distal esophageal (mucosal) ring, peptic or malignant esophageal stricture, or eosinophilic esophagitis. Immediate evaluation of the airway, assessment of the urgency of removal, radiological evaluation to localize the object, endoscopic or surgical retrieval, and subsequent monitoring for complications are essential steps in the management.

Endoscopic ultrasound-guided fine needle aspiration for smooth benign appearing esophageal stricture due to metastatic breast cancer

Metastatic breast cancer is an uncommon cause of esophageal stricture. We present an 80 year-old woman with past medical history of locally advanced breast cancer who admitted for evaluation of dysphagia. Barium swallow (i.g. esophageal fluoroscopy) demon­strated moderate irregular narrowing in the distal thoracic esophagus. Endoscopy revealed distal esophageal stricture with normal esophageal mucosa and computed tomography demonstrated thickened wall in the distal esophagus and the proximal stomach. Endoscopic biopsy of esophagus revealed no malignancy. Thus, we performed endoscopic ultrasound-guide fine needle aspiration (EUS-FNA) and cytological results were consistent with metastatic breast cancer. Diagnosis of malignant esophageal stricture due to metastasis from other primary is often challenging and requires a high index of suspicion. EUS-FNA is an alternative diagnostic technique in such cases when endoscopic biopsy fails to obtain adequate specimen.

Covered metallic stents for individualized treatment of proximal esophageal strictures

Objective To evaluate the efficacy and safety of covered metallic stentts in the manage- ment of proximal esophageal strictures. Methods Retrievable covered self-expanding metallic stents were inserted individually in 43 patients with malignant strictures of the proximal esophagus. Main outcome meas- ures included improvement of dysphagia, sealing of fistula and complications were evaluated. Results A to- tal of 45 stents were placed in 43 patients, with a success rate of 95.6% （43/45） at the first stent place- ment attempt. The dysphagia score improved significantly from 3.3 ±0. 6 to 1.8 ±0. 9 （ P 〈 0. 001 ）, with 18 having an excellent response and 25 having a good response. Improvement rate of dysphagia was 95.6% （43/45）. Fistula sealing was achieved in 7 of 9 patients （77.8%）. Early complications included severe pain （ n = 5 ）, mediastinal emphysema （ n = 1 ）, moderate fever （ n = 9） and collapse of the proximal end of the stent （ n = 1 ）, while late complications included migration （ n = 3） and tissue overgrowth （ n = 6）. Con- clusion Retrievable covered metallic stent placement is effective and safe for the palliation of obstructive dysphagia and sealing of fistulas in malignant proximal esophageal strictures. Key words: Esophageal strictures ; Esophageal fistula; Covered metallic stents ; Individualizedtreatment

Esophageal self-expandable stent material and mesh grid density are the major determining factors of external beam radiation dose perturbation: results from a phantom model

Self-expandable esophageal stents are increasingly used for palliation or as an adjunct to chemoradiation for esophageal neoplasia. The optimal esophageal stent design and material to minimize dose perturbation with external beam radiation are unknown. We sought to quantify the deviation from intended radiation dose as a function of stent material and mesh density design. A laboratory dosimetric film model was used to quantify perturbation of intended radiation dose among 16 different esophageal stents with varying material and stent mesh density design. Radiation dose enhancement due to stent backscatter ranged from 0 % to 7.3 %, collectively representing a standard difference from the intended mean radiation dose of 1.9 (95 % confidence interval [CI] 1.5 - 2.2). This enhancement was negligible for polymer-based stents and approached 0 % for the biodegradable stents. In contrast, all metal alloy stents had significant radiation backscatter; this was largely determined by the density of mesh design and not by the type of alloy used. Stent characteristics should be considered when selecting the optimal stent for treatment and palliation of malignant esophageal strictures, especially when adjuvant or neo-adjuvant radiotherapy is planned.

Polytetrafluoroethylene-Covered Retrievable Expandable Nitinol Stents for Malignant Esophageal Obstructions: Factors Influencing the Outcome of 270 Patients

The purpose of this study was to evaluate the clinical effectiveness of polytetrafluoroethylene (PTFE)-covered retrievable expandable nitinol stents in patients with malignant esophageal strictures and to identify prognostic factors associated with clinical outcomes. From 2001 to 2010, 320 PTFE-covered stents were placed in 270 patients. Technical and clinical success, complications, survival, and stent patency were measures of clinical effectiveness. The relationships among complications and age, sex, stricture location, stricture length, chemotherapy alone, chemoradiotherapy, and malignancy source were examined. Independent prognostic factors of overall survival and stent patency were identified. Stent placement and removal were technically successful and tolerated without procedural complications, and 98% of patients achieved clinical success. The complication rate was 30%. Two removed stents exhibited covering membrane separation. Chemotherapy was associated with increased stent migration (p = 0.002). Stricture location and chemoradiotherapy were associated with esophagorespiratory fistula development (p = 0.033 and p < 0.001, respectively). Median and mean survival periods were 114 days (95% CI, 102-126 days) and 166 days (138-193 days). Chemotherapy and chemoradiotherapy were independent prognostic factors for survival (p = 0.050 and p = 0.032, respectively). The median and mean stent patency periods were 60 days (41-79 days) and 90 days (71-108 days). Chemoradiotherapy was the only independent prognostic factor for stent patency (p = 0.012). The PTFE-covered stents were clinically effective. Membrane degradation was not evident, although 0.7% of the patients experienced covering membrane separation. Chemotherapy was associated with increased migration and prolonged survival. Chemoradiotherapy was associated with increased esophagorespiratory fistula formation and decreased stent patency.

Self-expanding Metal Stents for Palliative Treatment of Esophageal Carcinoma

To investigate the risk factors for the development of fatal massive bleeding after esophageal stenting in patients with malignant esophageal lesions. We performed a retrospective analysis of 216 patients with malignant esophageal stricture and esophageal fistulae who received esophageal stents recruited from January 2005 to December 2010 from the Shengjing Hospital of China Medical University. The patients were divided into 2 groups on the basis of the occurrence of fatal upper gastrointestinal bleeding. We evaluated the significance of sex, tumor site, type of stent, stent location, concomitant radiotherapy, esophageal fistulae, and tracheal stent as factors contributing to the development of esophageal bleeding in the 2 groups. Fatal bleeding developed in 6.9% (15/216) of patients. These patients developed massive hematemesis and died shortly thereafter. The mean and median survival times for the remaining 201 patients were 182.3 and 75.5 days, respectively. The incidence of fatal bleeding was significantly higher among patients with esophageal fistulas and in patients with concomitant tracheal stents compared with those with neither condition. No significant relationship was identified between the incidence of fatal bleeding and age, sex, stent type, stent location, or radiotherapy. Multivariate regression analysis revealed that the presence of esophageal fistula and concomitant tracheal stent were closely related to fatal postoperative bleeding. The presence of esophageal fistulae and concomitant tracheal stent are important factors contributing to heavy esophageal bleeding after esophageal stenting.

Esophageal Stent Migration Leading to Pneumothorax and Esophageal-Pleural Fistula: A Rare but Important Complication

Purpose: Esophageal stents are used in the management of malignant dysphagia. Covered self-expanding stents are standard practice in esophageal cancer as either palliation or a bridge to surgical resection. Stent placement carries a risk of complications, including aspiration pneumonia, fistula formation, and stent migration. More severe complications such as stent fracture and jejunal perforations have been reported. Case Report: We report a case of a 63-year-old woman with a history of a malignant esophageal stricture who underwent placement of a fully covered esophageal stent. The procedure was well tolerated with symptom improvement. She was then treated with chemotherapy and radiation with ultimate plans for surgical resection. Over the next six weeks, she presented to the hospital twice for chest pain. Two upper endoscopies during this time revealed a patent esophageal stent in proper position. Eight weeks after initial stent placement, she represented with persistent nausea and dysphagia. An upper endoscopy revealed stent migration with mucosal ulceration in the mid-esophagus from previous stent placement. The stent was pulled back into proper position with a rat-toothed forceps. She returned two weeks later with acute dyspnea and chest pain. A CXR revealed a right-sided tension pneumothorax. A chest tube was placed and immediately drained bilious liquid. A chest CT demonstrated erosion of the proximal end of the stent through the esophagus into a contained posterior mediastinal space which communicated with the right pleural cavity. Emergent upper endoscopy revealed the proximal portion of the stent eroding through the esophagus with an area of visible pleura. Stent removal was attempted but unsuccessful. The stent was then grasped with a rat-toothed forceps and pulled back into the esophagus to seal the visible defect. Twelve hours later, a CXR again showed stent migration. A repeat endoscopy revealed the proximal end of the stent within the pleura. It was pulled back to cover the defect and a second partially covered esophageal self-expanding stent was placed within the previously placed stent. Unfortunately, the patient's respiratory status continued to deteriorate and she passed away a few days later. Discussion: This case describes a rare complication of esophageal stent placement: pneumothorax and esophageal-pleural fistula development. Although esophageal stents can be beneficial in select patients with malignant strictures, stent migration is a common complication. This case highlights the importance of not only recognizing these complications, but also the management dilemmas and endoscopic challenges they bring.

How to design the optimal self-expandable oesophageal metallic stents: 22 years of experience in 645 patients with malignant strictures

To evaluate the clinical efficacy and safety of self-expandable metallic stent (SEMS) placement for malignant oesophageal strictures and their relationship with stent designs. Seven generations of SEMS were used to treat 645 consecutive patients with oesophageal strictures. Logistic regression models were constructed to identify predictive factors associated with complications. Stent placement was technically successful in 641 of 645 patients (99.4%). The clinical success rate was 95.5%. There were 260 (40.3%) complications after stent placement. Due to complications, 68 stents were removed; 66 of 68 stents (97.1%) were removed successfully. Stainless steel (SS) stents (odds ratio [OR] 4.18; 95% confidence interval [CI] 2.10, 8.32) and radiation therapy (RT) before stent placement (OR 4.23; CI 2.02, 8.83) were significantly associated with severe pain. Flared ends (OR 9.63; CI 3.38, 27.43), stricture length <6 cm (OR 2.01; CI 1.13, 3.60), and a stent diameter <18 mm (OR 3.00; CI 1.32, 6.84) were predictive factors of stent migration. Polyurethane membranes were associated with more frequent tumour ingrowth than polytetrafluoroethylene (PTFE) membranes (P = 0.002). Despite the relatively high complication rate, retrievable self-expandable PTFE-covered nitinol stents equipped with a head and a tail appeared to be an effective treatment for malignant oesophageal strictures.