Oesophageal stent
A self-expanding tube holding the gullet open, almost always to palliate cancer dysphagia. The ED problems: it blocks (often with food), it can migrate, and chest pain after one may be a perforation.
Also called: oesophageal stent, esophageal stent, SEMS, self-expanding metal stent, self-expandable metal stent, gullet stent, food pipe stent, covered stent
What it is
An oesophageal stent is a self-expanding metal mesh tube (SEMS) placed endoscopically to hold the oesophagus open. The overwhelming majority are placed to palliate malignant dysphagia - to let a patient with incurable oesophageal (or nearby) cancer swallow: ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass
. Some are placed temporarily for benign strictures, leaks or perforations, and a large-diameter one is occasionally used for refractory variceal bleeding.
For the ED, the point is that these patients are usually palliative, the stent is working when they can swallow, and the device fails in a few predictable ways: it re-obstructs (tumour overgrowth or an impacted food bolus), it migrates, it causes pain or bleeding, or it erodes to form a fistula into the airway. A stent-in-situ problem is for the endoscopy team; your job is to recognise it, relieve distress and refer.
How to recognise it
- A patient with known oesophageal or mediastinal cancer who had a stent placed to help swallowing, now attending with swallowing difficulty, pain, vomiting or regurgitation.
- Recurrent dysphagia after a period of relief - suggesting tumour in/overgrowth or a food-bolus blockage within the stent.
- The stent itself is not usually visible; its presence comes from the history, the clinic letter or imaging (a metal mesh tube in the oesophagus on chest x-ray or CT).
What goes wrong
Blockage - food bolus or tumour overgrowth
Return of dysphagia, drooling, inability to swallow saliva, or food 'sticking'. ESGE lists late ingrowth/overgrowth (14 %)
among the commonest late events; an impacted food bolus is the acute version.
Red flag
Complete obstruction with inability to swallow saliva risks aspiration - keep the patient nil by mouth, sit them up, and refer urgently for endoscopy. Food-bolus management overlaps the foreign-body pathway; do not blindly push anything down.
Stent migration
Sudden change in symptoms - dysphagia returns, or new lower chest/abdominal pain - as the stent moves down, sometimes into the stomach.
Red flag
A migrated stent can obstruct or perforate downstream. It needs endoscopic assessment; do not attempt to retrieve or reposition it.
Perforation or severe chest pain
New severe chest or back pain, surgical emphysema, fever, or signs of mediastinitis - during or after stent placement, or from erosion later.
Red flag
Suspected oesophageal perforation is a surgical emergency. Severe pain is common even without perforation (ESGE: late severe pain (15 %)
), but new severe pain with sepsis or emphysema needs urgent imaging and the upper-GI surgical and endoscopy teams.
Bleeding or aero-digestive fistula
Haematemesis or melaena; or coughing/choking on swallowing with fever - a stent eroding into the airway. ESGE: The symptoms of an esophageal fistula include cough, fever, and pneumonia
.
Red flag
A fistula causes aspiration and pneumonia and signals advanced disease; keep nil by mouth and refer. Major bleeding from an eroding stent (into a great vessel) is catastrophic and rare - resuscitate and call for help.
The first ten minutes
- Assess the airway and swallowing. If the patient cannot swallow their own saliva, keep them nil by mouth, sit them upright and suction as needed - aspiration is the immediate risk.
- Treat it as recurrent obstruction until proven otherwise and arrange urgent endoscopy; do not force food, fluids or a tube past a suspected blockage.
- New severe chest pain, fever, surgical emphysema or sepsis after a stent - think perforation or fistula, image (CT), and involve upper-GI surgery and endoscopy.
- Remember the person, not just the stent - these patients are usually palliative, often frail, and may have pain, nutrition and advance-care-planning needs that matter as much as the mechanical problem.
- Call the endoscopy / upper-GI team for any stent that has blocked, migrated, or is bleeding.
Do not
Who owns it
The upper-GI / endoscopy team (and the patient's oncology / palliative care team) own the stent. Tell them when and why it was placed, what has changed, whether the patient can swallow saliva, and any pain, bleeding or fever.
Who to call
The team and the criteria are national. The phone number is local, and this tool does not know it. Find it once, now, and write it on the department's own card — that is the part no website can do for you.
- Say the device name first
- Open with laryngectomy, LVAD, shunt — the single word changes who comes and what they bring. Do not bury it in the history.
- Say what you have already established
- Whether the device is patent, whether it has been removed or disturbed, and what you have already tried. The specialist is deciding whether to walk or run.
- Ask who owns it out of hours
- Device ownership and the on-call route often differ from the implanting specialty, and it is frequently a regional centre rather than your own hospital.
- The patient's own team is a resource, not an afterthought
- Named nurse specialists, home-care companies and device helplines answer questions nobody else can, and the patient usually has the number.
When the device is not the problem
A patient with a device gets pneumonia, sepsis, pulmonary oedema and myocardial infarction at the same rate as everybody else. The device is the most visible thing about them and it attracts the whole assessment.
- The NTSP says it out loud
- The project's own manual warns that
patients with tracheostomies can become unwell with all the problems that other patients get too. It is easy to become fixated with the tracheostomy.
The same sentence applies to every device in this tool. - Clear the device, then leave it
- Establish that the device is doing its job — the stoma is patent, the line draws back, the pump is running — and then assess the patient as you would anyone else.
- The anchoring runs both ways
- The opposite error is treating a device complication as a medical illness: a blocked gastrostomy read as vomiting, a baclofen pump failure read as sepsis.
- NTSP manual — Red flags · read in full
What the patient will be carrying
Patients usually carry oncology clinic letters recording the stent and their treatment plan, and often have a specialist nurse or palliative-care contact who knows the history.
Scope of this page
This page covers recognising problems with an oesophageal stent that is already in place: blockage, migration, perforation, bleeding and fistula, and the safe first steps. It does not cover the decision to stent, stent selection or placement technique (an ESGE/endoscopy matter), nor the detailed management of an impacted food bolus - for which see the foreign-body pathway. Oesophageal stents are overwhelmingly an adult, palliative device; paediatric oesophageal stenting is a rare specialist scenario directed by paediatric surgery.