Gastrointestinal: Self‐expanding metal stents for benign esophageal strictures

Abstract

A woman, aged 78, was admitted to hospital for endoscopic balloon dilatation of a tight esophageal stricture caused by reflux esophagitis. As the stricture was difficult to dilate and she refused surgery, she was treated by placement of a self-expanding metal stent. After the procedure, dysphagia resolved and the patient returned to a normal diet. Although she remained asymptomatic, upper gastrointestinal endoscopy was repeated after 29 months. Within the stent, the patient had an elevated and somewhat nodular lesion that extended from the proximal to the distal end of the stent (Fig. 1). Biopsies only revealed inflammatory tissue. The unusual mucosal bridge was also shown on a barium swallow X-ray (Fig. 2). This inflammatory bridge seems likely to be an unusual tissue reaction to the presence of the metallic stent.There is only limited information on the use of self-expanding metal stents for the treatment of benign esophageal strictures. One issue is the type of stent because there is variation in the potential for endoscopic extraction. After stent placement, most patients experience good relief from dysphagia. Early complications appear to be uncommon but include chest pain and stent migration. The latter may also occur after weeks or months. Additional late complications include the development of strictures at the ends of the stent, usually the proximal end. This appears to be due to mucosal hypertrophy and granulation tissue, presumably caused by irritation from the stent. An extension of this process seems likely to have resulted in the mucosal bridge illustrated below. Rare complications include erosion of the stent through the esophageal wall or into the aorta with the development of infections or severe bleeding, respectively.

Evaluation von Stents zur Behandlung der benignen Ösophagusstenose im Kindesalter

“…Da auch die operative Resektion der Stenose mit nicht unerheblichen Risiken und einer hohen Morbidit ä t belastet ist [21] , erscheint der Versuch des passageren Stenose-Stentings vor einer operativen Korrektur indiziert. Verschiedene Stenttypen und Implantationstechniken wurden bisher beschrieben [5,12,15,20] . Wir haben in Analogie zu unseren Patienten im Erwachsenenalter neben den selbstexpandierenden Metall-und Plastikstents auch herk ö mmliche Plastiktubi angewendet.…”