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

Abstract

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.

Biodegradable esophageal stents for the treatment of refractory benign esophageal strictures

“…In a small series of 8 patients with RBES treated by BDS, there was a statistically significant difference in the interval between the endoscopic dilations necessary before stent placement, compared to the interval between stent placement and the first session of endoscopic dilation required after treatment with BDS: median: 34.3 days (interquartile range [IQR]: 23.1-48.3) vs. 149.5 days (IQR: 94.3-210), respectively; P=0.012 [32].…”

“…Adverse events originating from the respiratory system have also been described, such as de novo formation of an esophago-bronchial fistula, or respiratory pneumonia following stent release [47]. Finally, a few septic episodes have been reported, including a case of soft tissue infection [32,34]. Regarding cases of GI bleeding, this could be explained, at least partially, by an interaction between the degrading parts of the stent and the tissue that grows as a reaction to the chemical procedure taking place during BDS degradation.…”

Treatment of refractory post-esophagectomy anastomotic esophageal strictures using temporary fully covered esophageal metal stenting compared to repeated bougie dilation: results of a randomized controlled trial

“…While 80 % to 90 % of patients initially respond to dilation, most patients require more than one session to reach adequate dilation, and nearly 10 % will experience a refractory or recurrent stricture despite repeated dilation 6 . Perforation is the most serious complication of esophageal dilation, and carries a mortality rate of approximately 20 % 7 .…”

“…Adjuncts to management of difficult benign esophageal strictures include steroid injection, cautery, and topical application of the antiproliferative agent mitomycin C. Most recently, esophageal stenting techniques have been used in patients with esophageal strictures. Options for stenting include nonmetal (plastic) expandable stents, biodegradable stents, and self-expanding metal stents (SEMS) 6 10 11 12 13 14 15 . Over the past 20 years, SEMS have become available in a wide variety of materials and configurations.…”

Silicone-covered biodegradable magnesium stent for treating benign esophageal stricture in a rabbit model

“…Recently, biodegradable stents (BDS) have been used as an effective and accepted method to treat BES patients to improve their quality of life[14,15]. For example, polymer polylactic L-acid (PLLA) BDS exhibited a low complication rate in BES patients, but the high rate (77%) of early stent migration greatly limited its wider clinical application[16].…”