Esophageal Tandem Stenting above the Lower Esophageal Sphincter

Fully covered esophageal metal stents can be used for the conservative management of esophageal leaks, perforations, and fistulas. However, the risk of stent migration is high. The authors present a case of tandem esophageal stenting above the lower esophageal sphincter (LES) by taking advantage of the natural anchorage offered by the LES, with additional radial expansile force provided by the inner stent holding the outer stent in place. Besides tandem stenting, endoclip application is another option to reduce the risk of stent migration. The authors advocate the choice between tandem stenting versus endoclip application depending on the underlying pathology and endoscopist's preference. After distal migration, esophageal stents usually stay within the stomach due to their long length and large stent flanges. However, there are rare reports of small bowel obstruction, ileus, or perforation from migrated esophageal stents, usually above the ileocecal valve or within the duodenum. Our case also stresses the importance of timely stent removal and patient follow-up. This article is part of an expert video encyclopedia.