More than 50 % of patients with cancer of the esophagus and gastric cardia have incurable disease at presentation and require palliative treatment for dysphagia. Placement of a self-expanding metal stent has become the treatment of choice for the majority of these patients. As the incidence of adenocarcinoma of the distal esophagus is rising rapidly [ 1 ], it is likely that deployment of metal stents across the gastroesophageal junction (GEJ) will increase. However, stenting of tumors of the distal esophagus and gastric cardia constitutes a particular problem. In comparison with stents placed for more proximally located esophageal tumors, these procedures provide inferior palliation and may have a higher complication rate [ 2 ]. The aim of this review on metal stenting of obstructive tumors in the distal esophagus and gastric cardia is to describe the problems encountered, the types of stents currently in use, the outcome of stenting and the occurrence and possible causes of complications.