Polymeric Biodegradable Stent Insertion in the Esophagus

Abstract

Esophageal stent insertion has been used as a well-accepted and effective alternative to manage and improve the quality of life for patients diagnosed with esophageal diseases and disorders. Current stents are either permanent or temporary and are fabricated from either metal or plastic. The partially covered self-expanding metal stent (SEMS) has a firm anchoring effect and prevent stent migration, however, the hyperplastic tissue reaction cause stent restenosis and make it difficult to remove. A fully covered SEMS and self-expanding plastic stent (SEPS) reduced reactive hyperplasia but has a high migration rate. The main advantage that polymeric biodegradable stents (BDSs) have over metal or plastic stents is that removal is not require and reduce the need for repeated stent insertion. But the slightly lower radial force of BDS may be its main shortcoming and a post-implant problem. Thus, strengthening support of BDS is a content of the research in the future. BDSs are often temporarily effective in esophageal stricture to relieve dysphagia. In the future, it can be expect that biodegradable drug-eluting stents (DES) will be available to treat benign esophageal stricture, perforations or leaks with additional use as palliative modalities for treating malignant esophageal stricture, as the bridge to surgery or to maintain luminal patency during neoadjuvant chemoradiation.

Biodegradable esophageal stents for the treatment of refractory benign esophageal strictures

“…Currently, the European Society of Gastrointestinal Endoscopy (ESGE), based on moderate-quality evidence, recommends the temporary placement of self-expandable stents (covered metal, plastic and BDS stents) for RBES [24]. Despite the fact that BDS have also occasionally been used for other indications [25,26], treatment of RBES remains the only approved indication for BDS available in the market.…”

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

“…The initial value of radial force of the current BD stent can be maintained in physiological saline solution (pH 7, 37°C) for 6-8 weeks. After seven weeks, the radial force was dramatically decreased and the stent was completely degraded after 2–4 months [44]. The polymer stent degraded faster with a lower pH.…”

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

“…Esophageal stenosis can be alleviated through esophageal stent insertion, which has been widely used as an effective means to improve the quality of life for patients with BES[8-11]. Implantation of stents fabricated from many materials can be applied for treating BES.…”

“…Implantation of stents fabricated from many materials can be applied for treating BES. However, metallic stent implantation is associated with some severe complications, such as migration, tissue ingrowth, and in-stent restenosis[8-11], which significantly limits the use of metallic stents in BES. In addition, the temporary recyclable stent represents a simple and feasible approach to provide sufficient support in 10-14 days for treating BES, but it needs to be removed after use and frequently causes pain, significant foreign body reaction, as well as potential risks including perforation and bleeding[11].…”

“…In addition, the temporary recyclable stent represents a simple and feasible approach to provide sufficient support in 10-14 days for treating BES, but it needs to be removed after use and frequently causes pain, significant foreign body reaction, as well as potential risks including perforation and bleeding[11]. With the advancements in biological medical material technology, stents made from biodegradable alloy or polymer are extensively improved to be able to provide enough force to tear the BES and reduce complications caused by stents[8,12,13].…”