Siyal M, Asim M, Qureshi S, Ghazanfar S, Siddiqui AR, Ahmed N, Altaf A, Zakaria N, Yaseen A, Kakar F, Kadir S, Hasan MK, Niaz SK. Navigating self-expandable metallic stent placement in inoperable esophageal malignancies: A landmark-based technique using the vertebral column and diaphragm. World J Gastrointest Endosc 2026; 18(3): 116060 [DOI: 10.4253/wjge.v18.i3.116060]
Corresponding Author of This Article
Saad Khalid Niaz, FCPS, MRCP (UK), FRCP (LON), CCST GASTRO (UK), Professor, Department of Gastroenterology, Sindh Institute of Advanced Endoscopy and Gastroenterology, Dr. Ruth K.M. Pfau Civil Hospital, Baba-e-Urdu Road, Karachi 75000, Sindh, Pakistan. saadniaz@yahoo.co.uk
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mar 16, 2026 (publication date) through Mar 17, 2026
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Publication Name
World Journal of Gastrointestinal Endoscopy
ISSN
1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Siyal M, Asim M, Qureshi S, Ghazanfar S, Siddiqui AR, Ahmed N, Altaf A, Zakaria N, Yaseen A, Kakar F, Kadir S, Hasan MK, Niaz SK. Navigating self-expandable metallic stent placement in inoperable esophageal malignancies: A landmark-based technique using the vertebral column and diaphragm. World J Gastrointest Endosc 2026; 18(3): 116060 [DOI: 10.4253/wjge.v18.i3.116060]
World J Gastrointest Endosc. Mar 16, 2026; 18(3): 116060 Published online Mar 16, 2026. doi: 10.4253/wjge.v18.i3.116060
Navigating self-expandable metallic stent placement in inoperable esophageal malignancies: A landmark-based technique using the vertebral column and diaphragm
Mehreen Siyal, Muhammad Asim, Sajida Qureshi, Shahriyar Ghazanfar, Arif R Siddiqui, Naseer Ahmed, Abeer Altaf, Noval Zakaria, Asma Yaseen, Fahad Kakar, Shanil Kadir, Muhammad Khalid Hasan, Saad Khalid Niaz
Mehreen Siyal, Muhammad Asim, Sajida Qureshi, Shahriyar Ghazanfar, Arif R Siddiqui, Naseer Ahmed, Abeer Altaf, Noval Zakaria, Asma Yaseen, Fahad Kakar, Shanil Kadir, Saad Khalid Niaz, Department of Gastroenterology, Sindh Institute of Advanced Endoscopy and Gastroenterology, Karachi 75000, Sindh, Pakistan
Muhammad Khalid Hasan, Center for Interventional Endoscopy, AdventHealth, Orlando, FL 32804, United States
Author contributions: Niaz SK pioneered this novel technique for self-expandable metallic stent placement and imparted this technique to many endoscopists; Niaz SK and Siyal M contributed to the data collection, data analysis, manuscript writing, manuscript editing and provided final approval of the manuscript; Asim M contributed to study conception and design; Qureshi S, Ghazanfar S, Siddiqui AR, Ahmed N, Altaf A, Zakaria N, Yaseen A, Kakar F, Kadir S, and Hasan MK contributed to critical editing of the manuscript for important intellectual content. All authors approved the final submitted version and agreed to be accountable for all aspects of the work, including accuracy and integrity.
Institutional review board statement: This study was approved by the Ethics Committee of the Sindh Institute of Advanced Endoscopy and Gastroenterology (No. ERC/SIAG/Approval/2025/02).
Informed consent statement: This study was conducted retrospectively using data obtained from medical records. As no direct patient contact occurred and all data were anonymized, the requirement for individual informed consent was waived by the Institutional Review Board. An exemption letter was obtained from the institutional ethics committee, and conducted in accordance with the ethical standards of the Declaration of Helsinki. All radiographic images included in this retrospective study were fully anonymised and contain no identifiable patient information; therefore, specific consent for publication was not obtained.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. Due to patient privacy and institutional regulations, access to the data is limited to de-identified datasets and may require further ethical clearance.
Corresponding author: Saad Khalid Niaz, FCPS, MRCP (UK), FRCP (LON), CCST GASTRO (UK), Professor, Department of Gastroenterology, Sindh Institute of Advanced Endoscopy and Gastroenterology, Dr. Ruth K.M. Pfau Civil Hospital, Baba-e-Urdu Road, Karachi 75000, Sindh, Pakistan. saadniaz@yahoo.co.uk
Received: November 3, 2025 Revised: November 23, 2025 Accepted: January 15, 2026 Published online: March 16, 2026 Processing time: 132 Days and 8.9 Hours
Abstract
BACKGROUND
Self-expandable metallic stent (SEMS) placement is a palliative treatment for inoperable esophageal malignancies with the goal of improving the patient’s quality of life. Utilizing anatomical landmarks can simplify the procedure performed under fluoroscopy. Therefore, we proposed the utilization of the vertebral column and diaphragm as landmarks for SEMS placement under fluoroscopy.
AIM
To evaluate the technical success of using the vertebral column and diaphragm landmarks for SEMS placement.
METHODS
This retrospective cross-sectional study included 801 patients with inoperable esophageal malignancies who underwent SEMS placement for dysphagia due to malignant esophageal strictures from January 1, 2006, to December 31, 2024. The SEMS placement procedure utilized the vertebral column and diaphragm as landmarks. The primary endpoint was to assess the technical success of this novel technique for SEMS placement for the index procedure.
RESULTS
Among 801 patients (18-95 years; mean 50 ± 15 years), 408 (50.90%) were female. All presented with dysphagia (average duration: 3.84 months). Squamous cell carcinoma was the predominant etiology (594; 74.16%), followed by adenocarcinoma (207; 25.84%). Tumors involved the middle third of the esophagus in 365 patients (45.57%), and distant metastasis was the leading cause of inoperability (52.81%). Gastroesophageal junction involvement was observed in 240 patients (30.00%). Tracheoesophageal fistula was present in 48 cases (6.00%). Mean stricture length was 8.4 cm. 139 patients (17.40%) required pre-stent dilatation. SEMS length ranged from 8 cm to 18 cm. Technical success was 100% without major immediate adverse events. Repeat stenting was needed in 15 patients (1.87%) due to tumor overgrowth, and 11 (1.37%) required dilatation for tumor ingrowth.
CONCLUSION
Using the vertebral column and diaphragm as landmarks provides a simplified, safe, and reproducible method for SEMS placement. Larger prospective studies are needed to validate these results and assess long-term outcomes.
Core Tip: A novel, landmark-based technique for self-expandable metallic stent placement in patients with inoperable esophageal cancer was investigated in this study. By utilizing the vertebral column and diaphragm as anatomical guides, the procedure became more streamlined, cost-effective, and reproducible without compromising safety or technical success. We achieved a 100% success rate and minimal complications in 801 patients, indicating that this approach offers a practical alternative to traditional fluoroscopic or endoscopic guidance, especially in resource-limited settings.
