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Esophageal malignancies presenting with dysphagia from luminal obstruction generally are not resectable for cure, and palliative
therapy is the primary focus.
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Self-expandable metal stents (SEMS) have replaced plastic stents as a primary mode of palliation for malignant esophageal
obstruction because of the relative ease of insertion, lower initial morbidity, and larger stent diameter.
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Self-expandable metal stents are ideal for patients with midesophageal tumors.
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A majority of patients experience relief of dysphagia with SEMS and dietary modification, but the initial cost is high and
early morbidity may be significant.
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The placement of SEMS across the gastroesophageal junction may result in free reflux that may improve with a stent containing
a one-way gastric flap valve.
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The placement of SEMS in the cervical esophagus, although more difficult, less effective, and less well tolerated, also may
be successful.
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Coated SEMS are a treatment of choice for individuals with tracheoesophageal fistula.
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Delayed complications occur in up to 40% of patients and include stent migration, bleeding, perforation, fistula formation,
and occlusion. Most complications can be managed endoscopically and additional stents may be placed for tumor overgrowth.
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The comparison of three currently available SEMS for esophageal malignancy show no statistically significant differences with
regard to ease of placement, effectiveness, complications, and mortality.
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The use of SEMS for patients with benign disease is still considered experimental.
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