Self-Expanding Biodegradable Stents for Postoperative Upper Gastrointestinal Issues

Abstract

Background and Objectives:Endoscopic stenting is a minimally invasive treatment modality for patients with various gastrointestinal conditions. We evaluated the safety and efficacy of uncovered biodegradable stents for postoperative leaks and strictures in the upper gastrointestinal tract.Methods:This was a retrospective study of patients treated endoscopically with biodegradable stents from January 2010 through November 2017.Results:Thirteen patients were enrolled, 7 of whom were men. Their mean age was 46 (range, 21–82) years. The indications for stent placement were postoperative leakage and stricture in 9 and 4 patients, respectively. The primary diagnoses were obesity in 7 patients, gastric cancer in 5, and peptic ulcer in 1. The average time to stent placement after surgery was 35 (range, 17–125) and 166 (range, 153–185) days for patients with postoperative leakage and stricture, respectively. Stent insertion was successful at the first attempt in all patients. Complete resolution of the leak and stricture was achieved after stent application in 11 patients, for a clinical success rate of 85%. The mean follow-up duration was 50 (range, 24–76) months. There were no major complications.Conclusions:Compared to self-expanding metal and plastic stents, the main advantages of uncovered biodegradable stents are that they do not have to be removed and have a low migration rate. Our results suggest that these stents have promise for management of postoperative gastrointestinal complications. Further randomized trials with larger sample sizes are necessary to determine the role of biodegradable stents in the treatment algorithm.

Futuristic Developments and Applications in Endoluminal Stenting

“…Regarding role of BDS in management of esophageal transmural defects (Figures 1(c) and 1(d) ), the data is limited, with only two studies, comprising of 13 and 4 patients, wherein the clinical success ranged from 77.8 to 100%, but a drawback of mucosal reaction (2/4 patients) causing dysphagia requiring endoscopic dilation [ 25 , 26 ].…”

The Unhappy Gastric Conduit: A Medical Perspective

“…20 Side effects of stent placement include chest pain, foreign body sensation, stent migration, and mucosal erosion, though serious adverse events occur in less than 5% to 10% of procedures. 20,21 Endoscopic suturing alone as well as the use of over the scope clips (OTSC; Ovesco Endoscopy Gmbh, Tubingen, Germany) have also demonstrated efficacy in the closure of esophageal defects and can be used for management of anastomotic leaks in the right setting with experienced providers. Success rates for endoscopic clipping vary widely and are limited by somewhat smaller sample sizes but range from 56% to 100%.…”

Management of anastomotic leaks after esophagectomy and gastric pull-up

“…Biodegradable stents made of woven polydioxanone monofilament (SX-Ella; Milady Horakrove, Hradc Kralove, Czech Republic), which degrade by random hydrolysis accelerated by a low ambient pH have also been used in the management of upper gastrointestinal (GI) anastomotic leaks (23). Multiple studies have reported successful use of these biodegradable stents in closure of anastomotic leak after esophagectomy, diverticulectomy, gastric sleeve and gastrectomy in 80-85% of patients studied (23,24). Although biodegradable stents eliminate complications involved in stent removal and reportedly have a lower migration rate, they are more expensive (24).…”

“…Multiple studies have reported successful use of these biodegradable stents in closure of anastomotic leak after esophagectomy, diverticulectomy, gastric sleeve and gastrectomy in 80-85% of patients studied (23,24). Although biodegradable stents eliminate complications involved in stent removal and reportedly have a lower migration rate, they are more expensive (24). Additionally, many patients in this study exhibited concerning side effects including drooling, retrosternal pain, sensation of having a foreign object in the body, and aversion to water for up to 2 months (24).…”

“…Although biodegradable stents eliminate complications involved in stent removal and reportedly have a lower migration rate, they are more expensive (24). Additionally, many patients in this study exhibited concerning side effects including drooling, retrosternal pain, sensation of having a foreign object in the body, and aversion to water for up to 2 months (24). Though esophageal stents have proven to be a valuable tool for surgeons in the management of esophageal leak after esophagectomy, the need for serial trips to the operating room and potential major complications such as migration and erosion highlight the importance of judicious patient selection.…”