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Introduction
Self-expanding plastic stent (SEPS) was introduced in recent years. Because it is easily removed endoscopically, it can be used to treat both malignant and benign disorders of the esophagus; including strictures, fistulae and perforations. The present study evaluates our experience in the use of SEPS, assessing its efficacy and safety.

Methods
A prospectively collected database of the use of SEPS from 2007 to 2011 was retrospectively reviewed. Treatment efficacy was evaluated by comparing the pre- and post-stenting dysphagia score in patients who had esophageal strictures. Success of sealing of fistulae and perforations was also assessed. Short-term and long-term complications were analyzed.

Results
A total of 30 stents were inserted for 23 patients (20 men and 3 women). The median age was 69 yrs (range 51-85). Indications included benign stricture (20%, n=6), malignant stricture (20%, n=6), tracheo-esophageal fistula (10%, n=3), post esophagectomy anastomotic leak (16.7%, n=5) and benign perforation (33.3%, n=10).

For patients with stricture (both benign and malignant, n=10), the median dysphagia score improved from a pre-treatment score of 3 (liquid diet) to post-treatment score of 2 (semisolid diet), p<0.001. SEPS provided satisfactory sealing in all 3 patients who had tracheo-esophageal fistulae; none required additional intervention. Of the 5 patients with anastomotic leak, 3 were successfully managed by SEPS with sealing of leak after stenting. Closure was not achieved in the other 2, who required subsequent surgical management. In the 5 patients who had benign perforation, all had adequate sealing by SEPS and recovered. One patient required 5 stents in total because of repeated stent migration.

Tracheal compression occurred in one patient under benign perforation group immediately upon SEPS deployment. The SEPS was removed and the lesion was successfully managed using another SEPS of shorter length. This was the only short-term complication identified in present study. For delayed complications, migration was most frequently observed (40%, n=12). Other delayed complications included food bolus obstruction (10%, n=3), erosion to surrounding structure (0%, n=0) and tumor ingrowth (3.3%, n=1) were infrequently seen.

Conclusion
SEPS is a worthy alternative to metal stent in malignant disease and has emerged as a new tool for managing anastomotic leaks and benign perforations with a high success rate. Migration remains a major concern.