Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Cascade Guideline

Authors: Alanna Ebigbo, John Gásdal Karstensen, Lars Aabakken, Mário Dinis-Ribeiro, Manon Spaander, Olivier Le Moine, Peter Vilmann, Uchenna Ijoma, Chukwuemeka Osuagwu, Gideon Anigbo, Mary Afiheni, Babatunde Duduyemi, Hailemichael Desalegn, Thierry Ponchon, Cesare Hassan

Introduction

Dysphagia and obstruction are among the most common indications for upper gastrointestinal endoscopy in African countries [1]. In a survey conducted by the European Society of Gastrointestinal Endoscopy (ESGE) International Affairs Working Group (IAWG), benign esophageal strictures as well as malignant upper gastrointestinal obstruction were reported as some of the most prevalent diseases leading to gastrointestinal endoscopy [1].

Management of esophageal obstruction may vary, depending on the cause of obstruction as well as the availability of resources. According to the ESGE original guideline, it could involve, for example, stent placement, radiotherapy/brachytherapy, or bypass surgery [2]. For resource-limited settings, however, a number of additional factors need to be considered before recommendations can be made. These involve economic considerations and resource availability. Furthermore, patients in low-resource settings presenting with malignant esophageal obstruction are often unfit for surgery due to presentation with advanced malignant disease as well as comorbidities such as HIV/AIDS and tuberculosis [3]. For such situations, self-expanding metal stents (SEMS) of the esophagus may provide a suitable palliative option [3, 4].