Partially versus fully covered self-expanding metal stents for benign and malignant esophageal conditions: a single center experience Gulseren Seven • Shayan Irani • Andrew S. Ross • S. Ian Gan • Michael Gluck • Donald Low • Richard A. Kozarek Received: 15 May 2012 / Accepted: 4 December 2012 / Published online: 31 January 2013 Ó Springer Science+Business Media New York 2013 Abstract Background Fully covered self-expanding metal stents (FCSEMS), unlike partially covered SEMS (PCSEMS), have been used to treat benign as well as malignant con- ditions. We aimed to evaluate the outcome of PCSEMS and FCSEMS in patients with both benign and malignant esophageal diseases. Methods Data were reviewed of all patients who under- went SEMS placement for malignant or benign conditions between January 1995 and January 2012. Patients with cancer were followed for at least 3 months, until death or surgery. Patients with benign conditions had stents removed between 4 and 12 weeks. Patient demographics, location and type of lesion, stent placement and removal, clinical success, and adverse events were analyzed. Results A total of 252 patients (mean ± standard devia- tion age 68.5 ± 14 years; 171 male) received 321 SEMS (209 PCSEMS, 112 FCSEMS) for malignant (78 %) and benign (22 %) conditions. Stent placement and removal was successful in 97.6 and 95.6 % procedures. Successful relief of malignant dysphagia was noted in 140 of 167 patients (83.8 %) and control of benign fistulas, leaks, and perforations was noted in 21 of 25 patients (84 %), but only 8 of 15 patients (53 %) with recalcitrant benign strictures had effective treatment. Fifty-six patients (22.2 %) expe- rienced at least one stent-related adverse events. Migration was frequent, occurring in 61 of 321 stent placements (19 %), and more frequently with FCSEMS than PCSEMS (37.5 vs. 9.1 %, p \ 0.001). FCSEMS, benign conditions, and distal location were the variables independently associated with migration (p \ 0.001, p = 0.022, and p = 0.008). Patients with PCSEMS were more likely to have tissue in- or overgrowth than FCSEMS (53.4 vs. 29.1 %, p = 0.004). Conclusions Both PCSEMS and FCSEMS can be used in benign and malignant conditions; they are both effective for relieving malignant dysphagia and for closing leaks and perforations, but they seem less effective for relieving benign recalcitrant strictures. Stent migration is more common with FCSEMS, which may limit its use for the palliation of malignant dysphagia. Keywords Esophageal diseases Á Fully covered SEMS Á Partially covered SEMS Self-expanding metal stents (SEMS) have dramatically changed the treatment of unresectable esophageal cancer. Incorporation of an impermeable covering for SEMS reduced tumor ingrowth and facilitated experimentation with temporary stent placement for benign conditions, such as recalcitrant strictures and leaks [1–4]. However, par- tially covered metal stents (PCSEMS) have exposed bare- metal mesh ends that promote tissue embedding. This effectively prevents stent removal except for a very short duration after deployment [5], but it can also result in restenosis in as little as 2 months [6]. Fully covered self- expanding plastic stents (SEPS) were introduced, in part, to prevent some of these undesirable effects. However, SEPS G. Seven Á S. Irani Á A. S. Ross Á S. Ian Gan Á M. Gluck Á R. A. Kozarek (&) The Digestive Disease Institute at Virginia Mason, Virginia Mason Medical Center, 1100 9th Ave., Mail Stop C3-GAS, PO Box 900, Seattle, WA 98101, USA e-mail: richard.kozarek@vmmc.org; gasrak@vmmc.org D. Low Department of Thoracic and General Surgery, Virginia Mason Medical Center, 1100 9th Ave., Mail Stop C3-GAS, PO Box 900, Seattle, WA 98101, USA 123 Surg Endosc (2013) 27:2185–2192 DOI 10.1007/s00464-012-2738-x and Other Interventional Techniques