Esophageal self-expandable metallic stents (SEMS): Results of a national survey regarding practice and techniques

B. Dennert, S. T. Zierer, F. C. Ramirez

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

SEMS have changed the management of malignant dysphagia. The magnitude of SEMS use in the community, and the clinical outcomes is unknown. Objective: To determine the reasons for SEMS selection and practice techniques for their placement in the gastroenterology community. Material and Methods: A survey was mailed to members of the ASGE. Results: Of 3414 surveys mailed, only 212 responded (6.2%) 128 physicians had experience with the placement of SEMS (60%) and the remaining 84 (40%) did not. Self-reported practice settings for the users were: private 72%, academic 24%. and VAMC 4%. These figures did not differ from the non-user group. A total of 434 SEMS were placed. 75% of users had placed ≤ 3 SEMS. Dilation before SEMS Guidance for Deployment OTW TTS Endosc (E) alone Fluorosc(F) alone E+F 83 (65%) 40 (31%) 2 (2%) 19 (15%) 106 (83%) Verification Patency/Position Scope Thru SEMS Immed X-ray Ba Sw same day Ba Sw next day 78 (61%) 46 (36%) 14 (11%) 24 (19%) Patients were discharged home the same day by 20%, and the next day by 36% of respondents. The choice of SEMS was based on: perceived ease of placement 71 (55%); availability for coated form 62 (48%); availability of desired length 36 (28%); documented efficacy in clinical studies 27 (21%); company advertisement 23 (18%); advise from fellow physician 22 (17%); cost difference 20 (16%); negative past experience 16 (12.5%); perceived difference m stent strength II (8.6%). The SEMS chosen were: Ultraflex: 184 (42%); Wallstent: 183 (42%); Gianturco: 40 (9%); Endocoil 25 (6%). Forty-six percent (59) physicians considered the placement of SEMS as the first line therapy for dysphagia in unresectable malignancy. Conclusions: SEMS are increasingly being placed as a first line therapy for malignant dysphagia. Self reported techniques and stent choices vary widely Practice guidelines on the use of SEMS may be helpful.

Original languageEnglish (US)
Number of pages1
JournalGastrointestinal endoscopy
Volume43
Issue number4
DOIs
StatePublished - Jan 1 1996

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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