1: ESGE recommends placement of partially or fully covered
self-expandable metal stents (SEMSs) for palliation of malignant
dysphagia over
laser therapy,
photodynamic therapy, and esophageal bypass.Strong recommendation, high quality evidence. 2 : ESGE recommends
brachytherapy as a valid alternative, alone or in addition to stenting, in
esophageal cancer patients with malignant
dysphagia and expected longer life expectancy.Strong recommendation, high quality evidence. 3: ESGE recommends esophageal SEMS placement for sealing malignant tracheoesophageal or bronchoesophageal
fistulas. Strong recommendation, low quality evidence. 4 : ESGE does not recommend SEMS placement as a bridge to surgery or before preoperative
chemoradiotherapy because it is associated with a high incidence of adverse events. Other options such as
feeding tube placement are preferable. Strong recommendation, low quality evidence.
BENIGN DISEASE: 5: ESGE recommends against the use of SEMSs as first-line
therapy for the management of benign esophageal
strictures because of the potential for adverse events, the availability of
alternative therapies, and their cost. Strong recommendation, low quality evidence. 6: ESGE suggests consideration of temporary placement of self-expandable
stents for refractory benign esophageal
strictures. Weak recommendation, moderate quality evidence. 7: ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal
strictures because of their very low risk of embedment and ease of removability. Weak recommendation, low quality evidence. 8: ESGE recommends the
stent-in-
stent technique to remove partially covered SEMSs that are embedded in the esophageal wall. Strong recommendation, low quality evidence. 9: ESGE recommends that temporary
stent placement can be considered for the treatment of leaks,
fistulas, and perforations. No specific type of
stent can be recommended, and the duration of stenting should be individualized. Strong recommendation, low quality of evidence. 10 : ESGE recommends considering placement of a fully covered large-diameter SEMS for the treatment of esophageal variceal
bleeding refractory to medical, endoscopic, and/or radiological
therapy, or as initial
therapy for patients with massive
bleeding. Strong recommendation, moderate quality evidence.