Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy

Background: Self-expanding metallic stents (SEMS) are effective in relieving the symptoms of obstructing esophagogastric malignancy. While complications with SEMS have been described, factors influencing such occurrence have not been defined. Methods: Self-expanding Gianturco-Rösch Z-stents were placed successfully in 59 patients with obstructing esophagogastric malignancies. Results: Early procedure-related complications occurred in 6 patients (10%) and were usually minor. Twenty-three late complications occurred in 22 patients (37.5%). Life-threatening complications occurred in 9 patients (15%), including gastrointestinal bleeding (7), perforation (1), and tracheoesophageal fistula (1) and contributed to all five deaths. Eight of 22 patients with prior radiation and/or chemotherapy (36.4%) had life-threatening complications compared to 1 or 37 (2.5%) without prior therapy (p=0.001). Stent-related mortality occurred in 5 of 22 (23%) patients with prior therapy compared to none of the 37 without prior therapy (p=0.005). Multivariate analysis confirmed the association between prior radiation and/or chemotherapy and life-threatening complications (p=0.012; odds ratio, 32.63) and also an association with female gender (p=0.032; odds ratio, 13.9). There was no association with tumor location or length, histologic type, age, prestent dysphagia grade, or previous surgical resection. Conclusion: Patients with prior radiation and/or chemotherapy have an increased risk of severe complications following placement of SEMS.