Plastic and Biodegradable Stents for Complex and Refractory Benign Esophageal Strictures

Abstract

Endoscopic stent placement is a well-accepted and effective alternative treatment modality for complex and refractory esophageal strictures. Among the currently available types of stents, the partially covered self-expanding metal stent (SEMS) has a firm anchoring effect, preventing stent migration and ensuring effective covering of a narrowed segment. However, hyperplastic tissue reaction driven by the uncovered mesh may prevent easy and safe stent removal. As an alternative, a fully covered SEMS decreases the recurrence of dysphagia caused by hyperplastic tissue ingrowth; however, it has a high migration rate. Likewise, although a self-expanding plastic stent (SEPS) reduces reactive hyperplasia, the long-term outcome is disappointing because of the high rate of stent migration. A biodegradable stent has the main benefit of not requiring stent removal in comparison with SEMS and SEPS. However, it still has a somewhat high rate of hyperplastic reaction, and the long-term outcome does not satisfy expectations. Up to now, the question of which type of stent should be recommended for the effective treatment of complex and refractory benign strictures has no clear answer. Therefore, the selection of stent type for endoscopic treatment should be individualized, taking into consideration the endoscopist's experience as well as patient and stricture characteristics.

Efficacy and histopathological esophageal wall damage of biodegradable esophageal stents for treatment of severe refractory esophageal anastomotic stricture in a child with long gap esophageal atresia

“…In terms of complications, the stent migration rates were variously 22.2 and 9.5 %, and post-stenting pain rates were 11.1 and 14.3 % [2,3]. These data showed results equal to or greater than those of SEPSs [9]. Van Boeckel and colleagues' report also showed that the success rate and complication rate of BD stents were equal to those of SEPSs, and that the rate of re-interventions after BD stenting was lower than that of SEPSs [12].…”

“…Currently, the use of SEPSs in patients with benign esophageal strictures has been proposed as an alternative to SEMS, because SEPSs have shown the same degree of relief of dysphagia; the lower major complication rate could reduce reactive tissue hyperplasia, and they could be removed more easily than SEMSs [7][8][9]. In pediatric patients, the use of SEMSs or SEPSs is limited, because the degree of damage to the esophageal wall following stenting is unclear [10,11], and esophageal stents have been fundamentally adapted only for the treatment of stenosis secondary to malignant lesions.…”

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“…[39] Newer modalities such as biodegradable stents and fully covered self-expandable metal stents are emerging alternatives for resistant strictures. [33,34,40]…”

Transplantation of epidermal cell sheets by endoscopic balloon dilatation to avoid esophageal re-strictures: initial experience in a porcine model

“…However, most patients develop refractory esophageal strictures after extensive ESD. Although there are several treatments for refractory strictures, their utility is limited 3 4 5 6.…”