Endoscopically placed stents: a useful alternative for the management of refractory benign cervical esophageal stenosis

Nogales, Óscar; Clemente, Ana Paula Grotti; Caballero-Marcos, Aránzazu; García-Lledó, Javier; Pérez-Carazo, Leticia; Merino, Beatriz; López-Ibáñez, María; Valderas, M.D. Pérez; Bañares, Rafael; González-Asanza, Cecilia

doi:10.17235/reed.2017.4795/2016

Cited by 9 publications

(6 citation statements)

References 14 publications

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“…It is believed that the typical wide flanges and short lengths of LAMSs may prevent stent migration. To date, LAMSs have only been investigated in mixed study populations restricted by small sample sizes [90][91][92][93][94]. More studies are needed to evaluate their potential benefit in RBES patients.…”

Section: Recommendationmentioning

confidence: 99%

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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Main recommendations Malignant disease 1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass.Strong recommendation, high quality evidence. 2 ESGE recommends brachytherapy as a valid alternative, alone or in addition to stenting, in esophageal cancer patients with malignant dysphagia and expected longer life expectancy.Strong recommendation, high quality evidence. 3 ESGE recommends esophageal SEMS placement for sealing malignant tracheoesophageal or bronchoesophageal fistulas. Strong recommendation, low quality evidence. 4 ESGE does not recommend SEMS placement as a bridge to surgery or before preoperative chemoradiotherapy because it is associated with a high incidence of adverse events. Other options such as feeding tube placement are preferable. Strong recommendation, low quality evidence. Benign disease 5 ESGE recommends against the use of SEMSs as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and their cost. Strong recommendation, low quality evidence. 6 ESGE suggests consideration of temporary placement of self-expandable stents for refractory benign esophageal strictures. Weak recommendation, moderate quality evidence. 7 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures because of their very low risk of embedment and ease of removability. Weak recommendation, low quality evidence. 8 ESGE recommends the stent-in-stent technique to remove partially covered SEMSs that are embedded in the esophageal wall. Strong recommendation, low quality evidence. 9 ESGE recommends that temporary stent placement can be considered for the treatment of leaks, fistulas, and perforations. No specific type of stent can be recommended, and the duration of stenting should be individualized. Strong recommendation, low quality of evidence. 10 ESGE recommends considering placement of a fully covered large-diameter SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive bleeding. Strong recommendation, moderate quality evidence.

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Section: Recommendationmentioning

confidence: 99%

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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“…In addition, dysphagia recurrence has been described as a consequence of BDS treatment [38]. While late dysphagia occurrence is frequently related to treatment failure and recurrence of the RBES, early dysphagia might be the result of BDS collapse, or more frequently tissue in-/overgrowth [43,44]. This hyperplastic tissue may significantly obstruct the esophageal lumen, leading to dysphagia.…”

Section: Safety Outcomes -Complicationsmentioning

confidence: 99%

“…For BDS-associated hyperplasia different techniques have been reported. Among them, coagulation using argon plasma, endoscopic balloon dilations and placement of a sequential stent have been applied with variable results [43][44][45][46].…”

Section: Safety Outcomes -Complicationsmentioning

confidence: 99%

Biodegradable esophageal stents for the treatment of refractory benign esophageal strictures

Gkolfakis

Siersema

Tziatzios

et al. 2020

aog

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This review attempts to present the available evidence regarding the use of biodegradable stents in refractory benign esophageal strictures, especially highlighting their impact on clinical success and complications. A comprehensive literature search was conducted in PubMed, using the terms "biodegradable" and "benign"; evidence from cohort and comparative studies, as well as data from one pooled analysis and one meta-analysis are presented. In summary, the results from these studies indicate that the effectiveness of biodegradable stents ranges from more than one third to a quarter of cases, fairly similar to other types of stents used for the same indication. However, their implementation may reduce the need for re-intervention during follow up. Biodegradable stents also seem to reduce the need for additional types of endoscopic therapeutic modalities, mostly balloon or bougie dilations. Results from pooled data are consistent, showing moderate efficacy along with a higher complication rate. Nonetheless, the validity of these results is questionable, given the heterogeneity of the studies included. Finally, adverse events may occur at a higher rate but are most often minor. The lack of high-quality studies with sufficient patient numbers mandates further studies, preferably randomized, to elucidate the exact role of biodegradable stents in the treatment of refractory benign esophageal strictures. AbstractI N V I T E D R E V I E W 2 P. Gkolfakis et al Annals of Gastroenterology 32

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“…Stents made of polydioxanone can be used in a variety of hollow organs, such as the esophagus [ 25 , 26 , 27 , 28 , 29 ], intestine [ 30 ], trachea [ 31 , 32 , 33 , 34 , 35 ], and bile ducts [ 22 , 24 , 36 , 37 , 38 ]. Rejchrt et al reported that a PPDX stent placed in a gastrointestinal tract maintained its properties (radial force and integrity) for 6–8 weeks, and the stent disintegration occurred after 11–12 weeks.…”

Section: Introductionmentioning

confidence: 99%

A Complex In Vitro Degradation Study on Polydioxanone Biliary Stents during a Clinically Relevant Period with the Focus on Raman Spectroscopy Validation

et al. 2022

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Biodegradable biliary stents are promising treatments for biliary benign stenoses. One of the materials considered for their production is polydioxanone (PPDX), which could exhibit a suitable degradation time for use in biodegradable stents. Proper material degradation characteristics, such as sufficient stiffness and disintegration resistance maintained for a clinically relevant period, are necessary to ensure stent safety and efficacy. The hydrolytic degradation of commercially available polydioxanone biliary stents (ELLA-CS, Hradec Králové, Czech Republic) in phosphate-buffered saline (PBS) was studied. During 9 weeks of degradation, structural, physical, and surface changes were monitored using Raman spectroscopy, differential scanning calorimetry, scanning electron microscopy, and tensile and torsion tests. It was found that the changes in mechanical properties are related to the increase in the ratio of amorphous to crystalline phase, the so-called amorphicity. Monitoring the amorphicity using Raman spectroscopy has proven to be an appropriate method to assess polydioxanone biliary stent degradation. At the 1732 cm−1 Raman peak, the normalized shoulder area is less than 9 cm−1 which indicates stent disintegration. The stent disintegration started after 9 weeks of degradation in PBS, which agrees with previous in vitro studies on polydioxanone materials as well as with in vivo studies on polydioxanone biliary stents.

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Endoscopically placed stents: a useful alternative for the management of refractory benign cervical esophageal stenosis

Cited by 9 publications

References 14 publications

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Biodegradable esophageal stents for the treatment of refractory benign esophageal strictures

A Complex In Vitro Degradation Study on Polydioxanone Biliary Stents during a Clinically Relevant Period with the Focus on Raman Spectroscopy Validation

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