self-expanding metal stent (SEMS)

Indications

• malignant esophageal stricture
  • not 1st-line for benign esophageal stricture
    • only short-term placement (> 6 weeks, max 3 months) should be considered
    • refractory or massive esophageal variceal bleeding
• preferred treatment for sealing malignant tracheo-esophageal or broncho-esophageal fistula

Contraindications

• SEMS placement as a bridge to surgery or before preoperative chemoradiation

Procedure

• placement of SEMS over thermal ablation or surgical bypass
  • do not use plastic stents (expandable or non-expandable)
• esophageal brachytherapy can be used in addition to SEMS placement.
• dual stenting of airway & esophagus may help if initial stent placement is inadequate
• radiation therapy is not recommended if a SEMS is present
• use 'stent-in-stent technique for removing embedded, partially covered SEMS

More general terms

• device (medical device)