Self-expanding plastic stents in treatment of benign esophageal conditions

Holm, Adrian N.; de la Mora Levy, Jose G.; Gostout, Christopher J.; Topazian, Mark D.; Baron, Todd H.

doi:10.1016/j.gie.2007.04.031

« Previous Next »Gastrointestinal Endoscopy
Volume 67, Issue 1 , Pages 20-25, January 2008

Self-expanding plastic stents in treatment of benign esophageal conditions

Current affiliations: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

Received 30 January 2007; accepted 30 April 2007. published online 18 October 2007.

Rochester, Minnesota, USA

Background

Recently, self-expanding plastic stents (SEPSs) have been proposed for the treatment of benign esophageal disease.

Objectives

Our purpose was to review our experience with SEPSs in patients with benign esophageal conditions.

Design

This was a retrospective case review of patients who underwent SEPS placement for benign esophageal disease, including (1) benign stricture, including reflux disease, ischemia, and idiopathic, (2) radiation-induced strictures, (3) anastomotic strictures, and (4) esophageal leak/fistulae.

Patients

Nineteen male and 11 female patients (average age 52.1 years, range 11-87 years) underwent SEPS placement.

Interventions

SEPS placement.

Main Outcome Measurements

Initial complications, stent migration, long-term complications, and treatment success according to clinical symptoms, follow-up endoscopy, or imaging.

Results

Eighty-three of 84 SEPS placements were successful. The most common complications were chest pain, dysphagia, nausea, and vomiting. No deaths were reported from stent placement. Stent migration was more frequent in proximal (30/44 stents, 68.1%) and distal (19/27 stents, 70.4%) compared with mid esophageal (3/10 stents, 30%). Migration was more frequent in stents placed for benign strictures (18/22 stents, 81.8%), anastomotic strictures (18/24 stents, 75%), and fistulae/leak (13/22 stents, 59.1%) compared with radiation-induced strictures (4/14 stents, 28.6%). Only 5 of 83 interventions (6%) resulted in long-term improvement after stent removal.

Limitations

This was a retrospective review, and patients were selected from a tertiary medical center.

Conclusion

Use of SEPSs for benign esophageal conditions resulted in frequent stent migration and few cases of long-term improvement. Further investigation is warranted to identify optimal patient populations and to guide future recommendations for the use of SEPSs.

Abbreviations: SEMS, self-expanding metal stent, SEPS, self-expanding plastic stent