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

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.