Year 2026 / Volume 118 / Number 2
Original
Is fluoroscopy necessary for esophageal self-expanding metal stents placement? A retrospective cohort study

88-94

DOI: 10.17235/reed.2025.11330/2025

Luís Miguel Relvas, Tânia Gago, Sónia Barros, Isabel Carvalho, Margarida Portugal, Francisco Velasco, Paulo Caldeira, Bruno Peixe,

Abstract
Introduction: self-expanding metal stents (SEMS) are widely used for the palliation of malignant esophageal conditions, including strictures, fistulas, and extrinsic compression. Placement may be guided by fluoroscopy, direct endoscopy, or both. However, few studies have directly compared the outcomes of these techniques. Objective: to compare the safety and efficacy of SEMS placement under endoscopic versus fluoroscopic control in a real-world clinical setting. Methods: we conducted a retrospective observational study of adult patients who underwent esophageal SEMS placement between January 2011 and December 2023. Patients were assigned to either the endoscopic control (EC) or fluoroscopic control (FC) group based on fluoroscopy availability. Outcomes included technical success, complication rates (early and late), and overall survival. Results: a total of 103 patients were included (mean age 69.4 years; 79 % male), with 43 receiving SEMS under EC and 60 under FC. The primary indication was malignant esophageal stricture (91.3 %). Technical success was achieved in 97 % of EC cases and 100 % of FC cases. Early complications occurred in 53 % of EC and 49 % of FC patients (p = 0.70), including chest pain (40.7 %), vomiting (22.3 %), and stent migration (5.8 %). Late complications occurred in 28 % of EC and 31 % of FC cases (p = 0.74), most commonly tumor overgrowth (14.6 %) and stent migration (10.7 %). Thirty-day mortality was 2.3 % in the EC group and 0 % in the FC group (p = 0.31). Median survival was 102 days (EC) versus 113 days (FC) (p = 0.44). Conclusions: SEMS placement under both endoscopic and fluoroscopic control is safe and effective, with no significant differences in complication rates, technical success, or survival. Endoscopic guidance may be a viable alternative to fluoroscopy in experienced hands, particularly in resource-limited settings.
Lay Summary
The primary treatment for malignant dysphagia is the placement of self-expanding metal stents (SEMS). Currently, stent placement can be performed under either fluoroscopic or endoscopic guidance, but the most effective and safest method has not yet been clearly established. In this study, we reviewed 114 SEMS procedures performed at our hospital between 2011 and 2023. Patients were treated using either fluoroscopic or endoscopic guidance, depending on equipment availability. We evaluated procedural success, complication rates, and patient outcomes over time and found that both methods were similarly effective and safe. Early and late complications (such as stent movement, pain, or tumor growth into the stent) occurred at comparable rates in both groups. Our findings suggest that either method can be used successful, depending on clinical circumstances and available resources.
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Relvas L, Gago T, Barros S, Carvalho I, Portugal M, Velasco F, et all. Is fluoroscopy necessary for esophageal self-expanding metal stents placement? A retrospective cohort study. 11330/2025


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Publication history

Received: 07/05/2025

Accepted: 10/08/2025

Online First: 29/09/2025

Published: 09/02/2026

Article revision time: 90 days

Article Online First time: 145 days

Article editing time: 278 days


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