Malignant Esophageal Stricture from Esophageal Cancer When Self-Expanding Metal Stent Did Not Achieve Palliation of Dysphagia

Clinical Scenario

This protocol addresses esophageal stricture caused by a malignant obstruction from esophageal adenocarcinoma or squamous cell carcinoma — the most common sources of malignant stricture in the esophagus — in patients who have not achieved adequate palliation of dysphagia through self-expanding metal stent (SEMS) insertion.

Prior Treatment & Escalation Trigger

The preceding line of management was self-expanding metal stent (SEMS) insertion, the standard preferred palliative approach for malignant dysphagia. This protocol is indicated when SEMS failed to achieve its primary goal: palliation of dysphagia.

Next-Step Approach (Partial Overview)

For strictures in anatomically challenging locations where stent placement is technically difficult, the protocol specifies an endoscopic palliative intervention targeting local disease. The full selection criteria, approach, and sequencing are available in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

Esophageal adenocarcinoma and squamous cell carcinoma are the most common causes of malignant strictures in the esophagus.

Photodynamic therapy as well as cryoablation have been suggested as palliative measures in areas that are difficult to treat with stents, such as the proximal esophagus.

DOI: 10.1016/j.giec.2025.02.002

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