Fracture of an esophageal stent: a rare but significant complication.

monly used to palliate malignant dyspha− gia. Typical complications include hemor− rhage, ulceration, perforation or fistula, compression of the trachea, stent migra− tion, and tumor ingrowth [1,2]. We report fracture of an esophageal stent as an unu− sual complication. A 50−year−old man was found on endos− copy to have a lower esophageal tumor. Biopsy confirmed a poorly differentiated adenocarcinoma. Palliative chemother− apy was initiated and an 18 mm ” 11 cm esophageal Choo stent (M.I. Tech, Seoul, South Korea) was placed to prevent dys− phagia. This stent type has a segmented body, the individual mesh segments being linked by a polymer covering. Seven months later, the patient re−pre− sented with coffee−ground vomiting and dysphagia. Endoscopy demonstrated fracture of the stent. A proximal segment had separated from the main stent body and was freely mobile in the esophagus, causing local trauma and bleeding that required transfusion. The main body was still covering the distal two−thirds of the tumor. The mobile fragment was extract− ed endoscopically. A 12 cm Ultraflex stent (Boston Scientific, Natick, Massachusetts, USA) was placed across the exposed up− per end of the tumor and the remaining parts of the Choo stent. This relieved the patient’s symptoms until his death. Fracture of an esophageal stent is a rarely encountered complication. A Medline search revealed only three reports on four patients. The authors of these re− ports believe that the fractures were caused by thermal overstrain induced by laser application [3] or defective material at the time of deployment [4], or that they were spontaneous [4, 5]. Our patient suffered a spontaneous stent fracture, his stent breaking in the polymer connection between metal mesh segments. It seems likely that the design of the Choo stent (individual segments of mesh connected by the polymer covering of the stent) may have contributed to this unusual event. We advise including failure of de− vice and/or stent fracture as potential complications in the information given to patients before they consent to stent insertion.