Only a small number of cohort studies on the use of biodegradable stent placement in the esophagus have been published, with only a few studies including 10 or more patients [
36,
57•,
58‐
66]. Repici, et al., included over 30 patients with a refractory benign esophageal stricture and placed an Ella BD stent (Ella CS, s.r.o., Czech Republic). Complete relief of dysphagia was reported in 43 % of patients after a median follow up of 53 weeks [
36]. In this study, eight (26 %) patients had recurrent dysphagia resulting from a recurrence of the stricture. No major complications were seen. In the above-mentioned study, van Boeckel, et al., reported complete relief of dysphagia in 33 % of patients treated with a biodegradable stent after a median of 166 days. In this study, major complications occurred in four (22 %) patients (two hemorrhage and two severe retrosternal pain) [
57•]. Ibrahim, et al., included 20 patients treated with an Ella BD stent. Half of them needed one or more additional procedures for recurrent dysphagia after six months of follow up [
64]. Van Hooft, et al., also concluded that placement of an Ella BD stent was an effective one step treatment in 60 % (6 of 10), of patients with an anastomotic stricture in the esophagus. No major complications were reported [
66]. The other 40 % of the patients required endoscopic dilation because of stricture related recurrent dysphagia. Recently, Hirdes, et al., reported the efficacy and safety of sequential Ella BD stent placement in 28 patients with a refractory benign strictures [
58]. A total of 59 biodegradable stents were placed in these patients. After initial stent placement patients remained dysphagia free for a period of 90 days, while after six months still 25 % of patients were dysphagia free. After placement of a second biodegradable stent in patients with recurrent stricture formation, patients remained dysphagia free for a median period of 55 days. After six months only 15 % of these patients were still dysphagia free. After a third biodegradable stent placement, the median dysphagia free period was 106 days but none of the patients remained dysphagia free after a period of six months. Major complications occurred in 29 %, 8 %, and 28 % of patients after one, two, and three Ella BD stents respectively. From these studies it can be concluded that a single biodegradable stent is only temporarily effective in the majority of patients. The relatively low radial force and degradable nature of these stents may contribute to early stricture recurrence [
67]. Stent placement was also found to be associated with considerable complications, like retrosternal pain and vomiting. However, in selected patients with a refractory benign esophageal stricture, sequential biodegradable stent placement can be an effective alternative to avoid the burden of frequent serial dilations. Further (prospective), studies including larger numbers of patients, and comparing biodegradable stents with fully covered SEMS (or SEPS), are needed. In those studies patient satisfaction and costs should be evaluated besides efficacy and safety.