This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE), endorsed by the European Society for
Radiotherapy and Oncology (ESTRO), the European Society of Digestive Endoscopy (ESDO), and the European Society for Clinical Nutrition and Metabolism (ESPEN). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations for malignant disease 1 ESGE recommends placement of partially or fully covered
self-expandable metal stents (SEMSs) for
palliative treatment of malignant
dysphagia over
laser therapy,
photodynamic therapy, and esophageal bypass (strong recommendation, high quality evidence). 2 For patients with longer life expectancy, ESGE recommends
brachytherapy as a valid alternative or in addition to stenting in
esophageal cancer patients with malignant
dysphagia.
Brachytherapy may provide a survival advantage and possibly a better quality of life compared to SEMS placement alone. (Strong recommendation, high quality evidence.) 3 ESGE recommends esophageal SEMS placement as the preferred treatment for sealing malignant tracheoesophageal or bronchoesophageal
fistula (strong recommendation, low quality evidence). 4 ESGE does not recommend the use of concurrent external
radiotherapy and esophageal
stent treatment. SEMS placement is also not recommended as a bridge to surgery or prior to preoperative
chemoradiotherapy. It is associated with a high incidence of adverse events and alternative satisfactory options such as placement of a
feeding tube are available. (Strong recommendation, low quality evidence.) Main recommendations for benign disease 1 ESGE recommends against the use of self-expandable
stents (SEMSs) as first-line
therapy for the management of benign esophageal
strictures because of the potential for adverse events, the availability of
alternative therapies, and costs (strong recommendation, low quality evidence). 2 ESGE suggests consideration of temporary placement of SEMSs as
therapy for refractory benign esophageal
strictures (weak recommendation, moderate evidence).
Stents should usually be removed at a maximum of 3 months (strong recommendation, weak quality evidence). 3 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal
strictures, because of their lack of embedment and ease of removability (weak recommendation, low quality evidence). 4 For the removal of partially covered esophageal SEMSs that are embedded, ESGE recommends the
stent-in-
stent technique (strong recommendation, low quality evidence). 5 ESGE recommends that temporary
stent placement can be considered for treating esophageal leaks,
fistulas, and perforations. The optimal stenting duration remains unclear and should be individualized. (Strong recommendation, low quality evidence.) 6 ESGE recommends placement of a SEMS for the treatment of esophageal variceal
bleeding refractory to medical, endoscopic, and/or radiological
therapy, or as initial
therapy for patients with massive esophageal variceal
bleeding (strong recommendation, moderate quality evidence).