Esophageal stent fracture: Case report and review of the literature

Table 1 Review of all cases of complete esophageal self-expanding metal stent fracture

Ref.	Country of Origin	Age (yr)/Gender	Reason for stent placement	Location	Pre-stent procedures	Initial stent	Stent fracture time after placement	Stent fracture management	Repeat stent placement
Current Case	United States	71/female	Dysphagia from metastatic esophageal squamous cell carcinoma	Mid esophagus	None	18 mm × 120 mm, Fully covered Nitinol SEMS - Bonastent, Standard Sci-Tech, Inc, Seoul, South Korea	45 wk	Proximal piece in the upper esophagus and distal fragment wedged in a hiatal hernia, both removed endoscopically	18 mm × 100 mm, Partially covered Nitinol SEMS - Wallflex, Boston Scientific, Marlborough, MA, United States
Wadsworth et al[8], 2010	United Kingdom	75/female	Dysphagia from refractory benign esophageal stricture	Distal esophagus	None	22 mm × 120 mm, Fully covered Nitinol SEMS - EBN stent, Diagmed Healthcare Ltd, Thirsk, United Kingdom	8 wk	Proximal piece in esophagus removed endoscopically, and distal fragment migrated to the colon, passed rectally	Was under consideration at the time of publication
Wiedmann et al[9], 2009	Germany	69/not reported	Dysphagia from metastastic EAC	Distal esophagus	None	22 mm × 160 mm, Fully covered Nitinol SEMS - Hanarostent, M.I.Tech Co., Inc, Seoul, South Korea	20 wk	Proximal piece in esophagus and distal fragment in the gastric antrum, both removed endoscopically	22 mm × 120 mm, Fully covered Nitinol SEMS - Hanarostent, M.I.Tech Co., Inc, Seol, South Korea
Chhetri et al[10], 2008	United Kingdom	50/male	Dysphagia from EAC	Distal esophagus	Palliative chemotherapy	18 mm × 110 mm, Fully covered Nitinol SEMS - Choostent, M.I.Tech Co., Inc, Seoul, South Korea	28 wk	Proximal piece in the esophagus removed endoscopically as it was causing trauma and bleeding, and the distal fragment wedged in the distal two-thirds of the tumor	18 mm × 120 mm, Partially covered Nitinol SEMS - Ultraflex Boston Scientific, Natick, MA, United States, was placed across the exposed upper end of the tumor and through the prior fractured stent
Doğan et al[11], 2005	Turkey	50/not reported	Dysphagia from metastastic EAC	Distal esophagus	None	18 mm × 100 mm, Uncovered Nitinol SEMS - Esophacoil, Medtronic InStent Inc., Minneapolis, MN, Unites States	10 wk	Proximal piece with tumor overgrowth and partial obstruction in the esophagus and distal fragment migrated and left in the stomach	18 mm, Uncovered Nitinol SEMS - Esophacoil, Medtronic InStent Inc., Minneapolis, MN, United States inserted through the proximal fractured fragment
Reddy et al[12], 2003	United Kingdom	76/male	Dysphagia from EAC at the GE junction	GE junction	Dilation and argon plasma ablation	18 mm × 100 mm, Uncovered Nitinol SEMS - Esophacoil, Kimal PLC, Uxbridge, United Kindom	22 wk	Proximal piece in the esophagus with tumor occlusion and the distal fragment in the stomach which subsequently migrated into the right inguinal hernia, removed surgically by enterotomy, followed by herniorrhaphy	Uncovered Nitinol SEMS - Esophacoil, Medtronic InStent Inc., Minneapolis, MN, United States inserted through the proximal fractured fragment
Reddy et al[12], 2003	United Kingdom	76/male (same patient)	Dysphagia from EAC at the GE junction	GE junction	None	Size NR, Uncovered Nitinol SEMS - Esophacoil, Kimal PLC, Uxbridge, United Kingdom	23 wk	Stent fracture in 2 places with proximal piece in the esophagus, middle piece in the stomach and the distal piece in the small intestine, not removed as patient died due to aspiration pneumonia	None
Altiparmak et al[13], 2000	Turkey	52/male	Dysphagia from EAC	NR	None	Size NR, Uncovered Nitinol SEMS - Wallstent, Schneider Inc., Plymouth, MN, United States	40 wk	Proximal piece in the esophagus and the distal fragment in the stomach causing a gastrocolic fistula with unsuccessful endoscopic removal requiring surgical gastrotomy and fistula repair	None
Grimley et al[14], 1999	United Kingdom	79/male	Dysphagia from refractory anastomotic stricture after resection of EAC	Proximal esophagus	Dilation of anastomotic stricture	18 mm × 100 mm, Uncovered Nitinol SEMS - Esophacoil, Medtronic InStent Inc., Minneapolis, MN, Unites States	8 wk	Proximal piece in the esophagus and the distal 2 cm fragment migrated into the stomach, subsequently passed rectally	Partially covered Nitinol SEMS - Ultraflex Boston Scientific, Galway, Ireland, was placed across the exposed upper end of the tumor and through the prior fractured stent

SEMS: Self-expanding metal stent; EAC: Esophageal adenocarcinoma; GE: Gastroesophageal.