Esophageal self-expandable metallic stents—indications, practice, techniques, and complications: results of a national survey

Abstract Background: The gastroenterology community's experience with esophageal self-expandable metallic stents (SEMS) is unknown. Methods: In order to assess indications, perioperative management, and self-reported complications associated with SEMS placement, a survey was mailed to ASGE members. Results: Of 3414 surveys mailed, 212 (6.2%) were completed and returned. One hundred twenty-eight physicians had experience with a total of 434 SEMS. Most physicians practiced in the private sector (72%), and 75% had placed 3 or fewer SEMS. Perceived ease of placement was the most common reason for choosing a SEMS (55%). Fluoroscopic and endoscopic guidance was used by 83% of respondents, and 81% allowed liquid diet after correct position and patency had been confirmed; 56% of respondents discharged their patients within 24 hours of SEMS placement. The rates of failure for full expansion (7.1%), stent misplacement (4.8%), and failure to deploy (3%) were higher than previously reported. Acute patient complications and delayed bleeding occurred less frequently than in reported series but mortality rates were similar. Conclusions: Ease of placement is the main reason for choosing a SEMS. Differences in complication rates, compared to previous studies on SEMS, may be related to operator experience and protocol requirements. When compared to plastic stents, complications were less frequent. (Gastrointest Endosc 1997;45:360-4.)