Biodegradable esophageal stents in benign and malignant strictures – a single center experience

 

 Permissions and Reprints

Background and study aims: Biodegradable (BD) esophageal stents were recently developed mainly for refractory benign strictures, but experience and available literature are limited.

Patients and methods: This was a retrospective observational study. All patients who had BD stents inserted due to refractory benign esophageal strictures or malignant strictures, or were awaiting radical radiotherapy/chemotherapy or neo-adjuvant therapy and esophagectomy between March 2011 and July 2015 were included.

Results: Stent placement was successful in all patients. Ten patients with benign strictures (3 male, median age 80.5 years, IQR: 68.75 – 89.5) were followed-up for a median of 171.5 weeks (IQR: 24 – 177.25). The interval between dilatations prior to the first BD stent placement (median: 34.25 days, IQR: 23.06 – 48.29) was significantly shorter than the interval between the first BD stent placement and the first intervention required (median: 149.5 days, IQR: 94.25 – 209.5) and this difference was statistically significant (P = 0.012). Ten patients with esophageal cancer (8 male, median age: 69 years, IQR: 59.25 – 80.75) were included and they were followed up for a median of 36 weeks (IQR: 26 – 58). Only 1 completed radical radiotherapy successfully, but developed refractory post-radiotherapy stricture. No one proceeded to esophagectomy and 50 % required a self-expanding metal stent (SEMS) at a median of 134 days (IQR: 100 – 263) following stent placement.

Conclusions: BD stents were successfully deployed in both benign and malignant strictures. They offered a prolonged dilatation-free interval in benign strictures, yet in the majority of patients, strictures recurred. In malignant strictures, stent patency was similar to that of benign strictures, which suggests a potential value in ensuring adequate oral intake during oncologic therapy. In our cohort, however, use of stents did not contribute to improved outcome.

• References

• 1 Parasa S, Sharma P. Complications of gastro-oesophageal reflux disease. Best Pract Res Clin Gastroenterol 2013; 27: 433-442
  CrossrefPubMedGoogle Scholar
• 2 Pregun I, Hritz I, Tulassay Z et al. Peptic esophageal stricture: medical treatment. Dig Dis 2009; 27: 31-37
  CrossrefPubMedGoogle Scholar
• 3 Pereira-Lima JC, Ramires RP, Zamin I et al. Endoscopic dilation of benign esophageal strictures: report on 1043 procedures. Am J Gastroenterol 1999; 94: 1497-1501
  CrossrefPubMedGoogle Scholar
• 4 Ramage JI, Rumalla A, Baron TH et al. A prospective, randomized, double-blind, placebo-controlled trial of endoscopic steroid injection therapy for recalcitrant esophageal peptic strictures. Am J Gastroenterol 2005; 100: 2419-2425
  CrossrefPubMedGoogle Scholar
• 5 Kim JH, Shin JH, Song H-Y. Benign strictures of the esophagus and gastric outlet: interventional management. Korean J Radiol 11: 497-506
  PubMedGoogle Scholar
• 6 Eloubeidi MA, Lopes TL. Novel removable internally fully covered self-expanding metal esophageal stent: feasibility, technique of removal, and tissue response in humans. Am J Gastroenterol 2009; 104: 1374-1381
  CrossrefPubMedGoogle Scholar
• 7 Dan DT, Gannavarapu B, Lee JG et al. Removable esophageal stents have poor efficacy for the treatment of refractory benign esophageal strictures (RBES). Dis Esophagus 2014; 27: 511-517
  CrossrefPubMedGoogle Scholar
• 8 Fuccio L, Hassan C, Frazzoni L et al. Clinical outcomes following stent placement in refractory benign esophageal stricture: a systematic review and meta-analysis. Endoscopy 2016; 48: 141-148
  Article in Thieme ConnectPubMedGoogle Scholar
• 9 Langer FB, Schoppmann SF, Prager G et al. Temporary placement of self-expanding oesophageal stents as bridging for neo-adjuvant therapy. Ann Surg Oncol 2010; 17: 470-475
  CrossrefPubMedGoogle Scholar
• 10 Abu Dayyeh BK, Vandamme JJ, Miller RC et al. Esophageal self-expandable stent material and mesh grid density are the major determining factors of external beam radiation dose perturbation: results from a phantom model. Endoscopy 2013; 45: 42-47
  Article in Thieme ConnectPubMedGoogle Scholar
• 11 Francis SR, Anker CJ, Wang B et al. Self-expanding stent effects on radiation dosimetry in esophageal cancer. J Appl Clin Med Phys 2013; 14: 4218
  PubMedGoogle Scholar
• 12 Li XA, Chibani O, Greenwald B et al. Radiotherapy dose perturbation of metallic esophageal stents. Int J Radiat Oncol Biol Phys 2002; 54: 1276-1285
  CrossrefPubMedGoogle Scholar
• 13 Jones CM, Griffiths EA. Should oesophageal stents be used before neo-adjuvant therapy to treat dysphagia in patients awaiting oesophagectomy? Best evidence topic (BET). Int J Surg 2014; 12: 1172-1180
  CrossrefPubMedGoogle Scholar
• 14 Fry SW, Fleischer DE. Management of a refractory benign esophageal stricture with a new biodegradable stent. Gastrointest Endosc 1997; 45: 179-182
  CrossrefPubMedGoogle Scholar
• 15 Stivaros SM, Williams LR, Senger C et al. Woven polydioxanone biodegradable stents: a new treatment option for benign and malignant oesophageal strictures. Eur Radiol 2010; 20: 1069-1072
  CrossrefPubMedGoogle Scholar
• 16 Krokidis M, Burke C, Spiliopoulos S et al. The use of biodegradable stents in malignant oesophageal strictures for the treatment of dysphagia before neoadjuvant treatment or radical radiotherapy: a feasibility study. Cardiovasc Intervent Radiol 2013; 36: 1047-1054
  CrossrefPubMedGoogle Scholar
• 17 Repici A, Vleggaar FP, Hassan C et al. Efficacy and safety of biodegradable stents for refractory benign esophageal strictures: the BEST (Biodegradable Esophageal Stent) study. Gastrointest Endosc 2010; 72: 927-934
  CrossrefPubMedGoogle Scholar
• 18 Hirdes MMC, Siersema PD, van Boeckel PGA et al. Single and sequential biodegradable stent placement for refractory benign esophageal strictures: a prospective follow-up study. Endoscopy 2012; 44: 649-654
  Article in Thieme ConnectPubMedGoogle Scholar
• 19 Griffiths EA, Gregory CJ, Pursnani KG et al. The use of biodegradable (SX-ELLA) oesophageal stents to treat dysphagia due to benign and malignant oesophageal disease. Surg Endosc 2012; 26: 2367-2375
  CrossrefPubMedGoogle Scholar
• 20 Lopes TL, Eloubeidi MA. A pilot study of fully covered self-expandable metal stents prior to neoadjuvant therapy for locally advanced esophageal cancer. Dis Esophagus 2010; 23: 309-315
  PubMedGoogle Scholar
• 21 van den Berg MW, Walter D, de Vries EMG et al. Biodegradable stent placement before neoadjuvant chemoradiotherapy as a bridge to surgery in patients with locally advanced esophageal cancer. Gastrointest Endosc 2014; 80: 908-913
  CrossrefPubMedGoogle Scholar
• 22 Hirdes MMC, Vleggaar FP, de Beule M et al. In vitro evaluation of the radial and axial force of self-expanding esophageal stents. Endoscopy 2013; 45: 997-1005
  Article in Thieme ConnectPubMedGoogle Scholar
• 23 Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc 2005; 62: 474-475
  PubMedGoogle Scholar