Quality Improvement Guidelines for Placement of Esophageal Stents

Esophageal cancer is now the sixth leading cause of death from cancer worldwide [1, 2]. During the past three decades, important changes have occurred in the epidemiologic patterns associated with this disease [1]. Due to the distensible characteristics of the esophagus, patients may not recognize any symptoms until 50% of the luminal diameter is compromised, explaining why cancer of the esophagus is generally associated with late presentation and poor prognosis [3]. Esophageal cancer has a poor outcome, with an overall 5 year survival rate of less than 10%, and fewer than 50% of patients are suitable for resection at presentation. As a result palliation is the best option in this group of patients [3, 4]. The aims of palliation are maintenance of oral intake, minimizing hospital stay, relief of pain, elimination of reflux and regurgitation, and prevention of aspiration [3, 5, 6]. For palliative care, current treatment options include thermal ablation [7‐9], photodynamic therapy [10‐12], radiotherapy [13], chemotherapy [14, 15], chemical injection therapy [16‐18], argon beam or bipolar electrocoagulation therapy [19], enteral feeding (nasogastric tube/percutaneous endoscopic gastrostomy) [20‐22], and intubation (self-expanding metal stents (SEMS) or semi-rigid prosthetic tubes) [5, 6, 23‐26] with different success and complications rates.