The use of biodegradable (SX-ELLA) oesophageal stents to treat dysphagia due to benign and malignant oesophageal disease

Griffiths, Ewen A.; Gregory, Catherine J.; Pursnani, Kishore; Ward, Jeremy; Stockwell, Robert

doi:10.1007/s00464-012-2192-9

Cited by 45 publications

(22 citation statements)

References 32 publications

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“…In line with Griffiths et al 19, we also documented a disappointingly low rate of progression to surgery (0 %). This was a selective group of patients in the context of a retrospective study who were considered fit for radical therapies but they were borderline with regard to their potential for curative interventions.…”

Section: Discussionsupporting

confidence: 92%

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Biodegradable esophageal stents in benign and malignant strictures – a single center experience

2016

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Background and study aims: Biodegradable (BD) esophageal stents were recently developed mainly for refractory benign strictures, but experience and available literature are limited. Patients and methods: This was a retrospective observational study. All patients who had BD stents inserted due to refractory benign esophageal strictures or malignant strictures, or were awaiting radical radiotherapy/chemotherapy or neo-adjuvant therapy and esophagectomy between March 2011 and July 2015 were included. Results: Stent placement was successful in all patients. Ten patients with benign strictures (3 male, median age 80.5 years, IQR: 68.75 – 89.5) were followed-up for a median of 171.5 weeks (IQR: 24 – 177.25). The interval between dilatations prior to the first BD stent placement (median: 34.25 days, IQR: 23.06 – 48.29) was significantly shorter than the interval between the first BD stent placement and the first intervention required (median: 149.5 days, IQR: 94.25 – 209.5) and this difference was statistically significant (P = 0.012). Ten patients with esophageal cancer (8 male, median age: 69 years, IQR: 59.25 – 80.75) were included and they were followed up for a median of 36 weeks (IQR: 26 – 58). Only 1 completed radical radiotherapy successfully, but developed refractory post-radiotherapy stricture. No one proceeded to esophagectomy and 50 % required a self-expanding metal stent (SEMS) at a median of 134 days (IQR: 100 – 263) following stent placement. Conclusions: BD stents were successfully deployed in both benign and malignant strictures. They offered a prolonged dilatation-free interval in benign strictures, yet in the majority of patients, strictures recurred. In malignant strictures, stent patency was similar to that of benign strictures, which suggests a potential value in ensuring adequate oral intake during oncologic therapy. In our cohort, however, use of stents did not contribute to improved outcome.

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Section: Discussionsupporting

confidence: 92%

“…Only 3 patients had a patent stent at the end of the follow-up period and were supposed to complete neoadjuvant chemotherapy prior to esophagectomy. Griffiths et al 19 included 16 patients with malignant strictures. Only 1 was waiting for surgery, 4 months after BD stent placement.…”

Section: Discussionmentioning

confidence: 99%

Biodegradable esophageal stents in benign and malignant strictures – a single center experience

2016

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“…165 Compared with uncovered SEMSs, covered SEMSs prevent tumor growth (53% vs 100%) and reduce restenosis (8% vs 37%) 166 Biodegradable stents have been developed, although their application is limited because of unknown long-term efficacy. 167 In patients with prior CRT, SEMSs can cause life-threatening complications. 168 Placement of a SEMS is also effective for closing malignant esophagorespiratory fistulas.…”

Section: Palliative Carementioning

confidence: 99%

Recent Advances From Basic and Clinical Studies of Esophageal Squamous Cell Carcinoma

et al. 2015

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Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive squamous cell carcinomas and is highly prevalent in Asia. Alcohol and its metabolite, acetaldehyde, are considered definite carcinogens for the esophagus. Polymorphisms in the aldehyde dehydrogenase 2 gene, which encodes an enzyme that eliminates acetaldehyde, have been associated with esophageal carcinogenesis. Studies of the mutagenic and carcinogenic effects of acetaldehyde support this observation. Several recent large-scale comprehensive analyses of the genomic alterations in ESCC have shown a high frequency of mutations in genes such as TP53 and others that regulate the cell cycle or cell differentiation. Moreover, whole genome and whole exome sequencing studies have frequently detected somatic mutations, such as G:C→A:T transitions or G:C→C:G transversions, in ESCC tissues. Genomic instability, caused by abnormalities in the Fanconi anemia DNA repair pathway, is also considered a pathogenic mechanism of ESCC. Advances in diagnostic techniques such as magnifying endoscopy with narrow band imaging or positron emission tomography have increased the accuracy of diagnosis of ESCC. Updated guidelines from the National Comprehensive Cancer Network standardize the practice for the diagnosis and treatment of esophageal cancer. Patients with ESCC are treated endoscopically or with surgery, chemotherapy, or radiotherapy, based on tumor stage. Minimally invasive treatments help improve the quality of life of patients who undergo such treatments. We review recent developments in the diagnosis and treatment of ESCC and advances gained from basic and clinical research.

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“…The duration of courses of radiotherapy (6-8 weeks) corresponds to the life span of the biodegradable stent [38]. However, if a biodegradable stent migrates during neoadjuvant therapy, there is no significant clinical impact due to its biodegradable properties, and if it has not migrated, it has substantially dissolved at the time of surgical resection [39].…”

Section: Technical Considerationsmentioning

confidence: 99%

Gastrointestinal stenting: Current status and imaging features

Malgras

Dico

Pautrat

et al. 2015

Diagnostic and Interventional Imaging

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The use of stents in the gastrointestinal tract has been subjected to major changes. Initially, the use of stents was restricted to malignant strictures in patients with metastatic disease. But thanks to reduction of the morbidity and mortality rates, they are now used with curative intention and in patients with benign diseases after careful selection. However, for patients presenting with colon obstruction due to an advanced colon carcinoma, the mortality and morbidity are still high. The purpose of this review is to provide an overview of indications, techniques and further developments of the stents in the gastrointestinal tract and to highlight the predominant role of multidetector row computed tomography (MDCT) in the detection of potential complications.

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The use of biodegradable (SX-ELLA) oesophageal stents to treat dysphagia due to benign and malignant oesophageal disease

Cited by 45 publications

References 32 publications

Biodegradable esophageal stents in benign and malignant strictures – a single center experience

Biodegradable esophageal stents in benign and malignant strictures – a single center experience

Recent Advances From Basic and Clinical Studies of Esophageal Squamous Cell Carcinoma

Gastrointestinal stenting: Current status and imaging features

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