Safety of long-term esophageal stent placement and a predictive model for restenosis: A double-center retrospective study.

BACKGROUND AND AIMS: Self-expanding metal stents (SEMS) relieve dysphagia but may cause complications. This study assessed the safety of long-term SEMS indwelling, identified risk factors, and developed a Cox model for restenosis prediction.

METHODS

A retrospective study was conducted at two centers, including 412 patients who underwent stenting (2015-2025). Complications were compared across indwelling times (< 30, 30-59, ≥ 60 days) and indications (benign, malignant). Logistic regression, Kaplan-Meier, and Cox analyses identified predictors, and a nomogram was constructed.

RESULTS

The overall complication rate was 64.6%. Migration was higher in the benign group (43.1% vs. 18.2%, P < 0.001), and fistula was higher in the malignant group (6.0% vs. 0.9%, P = 0.032). Indwelling ≥ 60 days increased migration (OR = 2.418, P = 0.008) and restenosis (OR = 2.336, P = 0.011). Longer stents reduced restenosis risk (OR = 0.987, P = 0.037). Malignant indication was an independent risk factor (HR = 3.661, P < 0.001). The nomogram showed good discrimination (AUC 0.78-0.81; C-index = 0.710).

CONCLUSION

Long-term stent placement (≥ 60 days) increased migration and restenosis but was generally manageable endoscopically, with no fatal events. In benign cases, moderate prolongation of stent indwelling was safe and feasible under close follow-up.