Self-expanding stent in the treatment of benign esophageal strictures: experimental study in pigs and presentation of clinical cases.

Abstract

The reaction of the normal esophageal wall to inserted self-expanding nitinol stents was studied in pigs. An inflammatory reaction with increasing fibrotic activity and degeneration of the muscular layers in the esophageal wall was demonstrated. Five patients with severe dysphagia secondary to benign esophageal strictures also underwent insertion of self-expanding nitinol stents. All of the stents expanded completely, with subsequent regression of dysphagia. One treated esophagus was resected and showed deep implantation of the stent meshwork in the esophageal wall. Significant stenoses secondary to tissue hyperplasia, located at the edges of the stent, occurred in two patients. These results show that self-expanding nitinol stents may be used for palliation of dysphagia in patients with benign esophageal strictures. Because of the observed reactions in the esophageal wall, such treatment should be restricted to selected patients until more experience has been gained.

Palliative treatment of obstructing esophageal cancer with nitinol stents: value, safety, and long-term results.

“…One patient had a single hematemesis withoutfurther problems [28], one stent migrated [29], and two were placed incorrectly [30]. One patient died of aspiration pneumonia that was directly related to stent placement [30], one died from a pulmonary embolus on the day of stent insertion [28], and another had a lethal myocardial infarction 6 days after stent placement.…”

Selection and evaluation of three interventional procedures for achalasia based on long-term follow-up

“…Three interventional procedures are used clinically for achalasia, namely pneumatic dilation, permanent metal stent dilation, and temporary metal stent dilation. These methods provide excellent immediate therapeutic efficacy, but their long-term results are unknow [1,2] . Therefore, we formulated several treatment plans for patients with achalasia from July 1994 to May 2002 and evaluated them in terms of long-term follow-up.…”

The Benign Strictures of the Esophagus

“…The most common complication is that the stent is embedded into the esophageal wall with the formation of granulation in the stent. This growth starts in 2-6 weeks after the insertion of the stent and causes the recurrence of stricture in 40% of patients (42).…”