Esophageal obstruction due to a collapsed biodegradable esophageal stent

Abstract

A 74-year-old man with a previous history of surgery for pharyngolaryngeal neoplasia and reconstruction in 2006 with muscle graft was referred to our unit for dysphagia. Upper endoscopy showed a narrow stricture at the muscle graftesophageal anastomosis that was 20 mm long. The patient underwent five sessions of esophageal dilation with the CRE Balloon Dilator (Boston Scientific, Natick, Massachusetts, USA) with early relapse and weight loss. Therapeutic options were discussed with the patient, and we decided to place an 80-mm SX-ELLA Esophageal Degradable BD stent (ELLA-CS, Hradec Králové, Czech Republic). It was placed under fluoroscopic guidance without complications. The patient presented an initial improvement from dysphagia grade 4 to dysphagia grade 2, but after 9 weeks he attended the emergency ward for aphagia. An urgent upper endoscopy was performed showing a collapse of the biodegradable stent mesh inside the esophageal lumen (• " Fig. 1); the collapsed mesh did not allow the passage of a standard Pentax endoscope. A foreign body forceps was used to remove the filaments of partially reabsorbed polydioxanone mesh until a clear lumen was obtained that allowed easy passage of the endoscope (• " Fig. 2). The patient was discharged from hospital the next day with an improvement of his dysphagia.

Black necrotic oesophagus following the use of biodegradable stent for benign oesophageal stricture: Figure 1:

“…Reported complications of biodegradable stents include retrosternal pain and stent migration. However, there are some recent reports of biodegradable oesophageal stents eroding into the tracheobronchial tree causing airway compromise [ 5 ], severe tissue reaction with hyperplastic in- and overgrowth causing stent obstruction [ 3 ] and even oesophageal obstruction due to their collapse [ 3 , 6 ].…”

A Review of Self-Expanding Esophageal Stents for the Palliation Therapy of Inoperable Esophageal Malignancies

“…They found that the stent degraded and collapsed after 9 weeks. The collapsed mesh did not allow the passage of a standard Pentax endoscope [41]. To overcome these issues of poor corrosion resistance and a quick loss of mechanical support of BD stents, Yuan et al mixed biodegradable poly( ε -caprolactone) (PCL) and poly(trimethylene carbonate) (PTMC) as the coated membrane to coat magnesium alloy stents for a fully biodegradable esophageal stent.…”

Polymeric Biodegradable Stent Insertion in the Esophagus

“…Other potential rare complications of BDS that have been addressed are biodegradable esophageal stents eroding into the tracheobronchial tree causing airway compromise [100], collapse of the biodegradable stent mesh inside the esophageal lumen [57,101], tracheoesophageal fistula [59] and a feeling of obstruction because food stuck in the BDS one months later [81].…”