A Comparison of Temporary Self-Expanding Plastic and Biodegradable Stents for Refractory Benign Esophageal Strictures

• Published in: Clinical gastroenterology and hepatology Vol. 9; no. 8; pp. 653 - 659
• Main Authors: van Boeckel, Petra G.A, Vleggaar, Frank P, Siersema, Peter D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2011
• Subjects: Absorbable Implants - adverse effects; Adult; Aged; Aged, 80 and over; Ella BD Stent; Esophageal Stenosis - surgery; Esophagus; Female; Gastroenterology and Hepatology; Humans; Male; Middle Aged; Plastics - adverse effects; Polyflex Stent; Stents - adverse effects; Swallowing; Treatment Outcome; BD; biodegradable; self-expanding metal stents; self-expanding plastic stent; Ella BD Stent; Swallowing; Esophagus; PEG; SEPS; RBES; percutaneous endoscopic gastrostomy; refractory benign esophageal strictures; SEMS; Polyflex Stent
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2011.04.006

Background & Aims It is a challenge to manage refractory benign esophageal strictures (RBES). We compared the efficacy and safety of self-expanding plastic stents (SEPSs) with placement of biodegradable stents for the treatment of RBES. Methods We studied 2 groups of consecutive patients with RBES who received temporary placement (6 weeks) of SEPSs (n = 20) or biodegradable stents (n = 18). Data were collected with respect to clinical outcome, complications, recurrent dysphagia, and reinterventions. Results SEPSs were removed in 16 (80%) patients. Stent placement was not successful in 1 patient, while stent removal was not performed in another 3 patients. Six (30%) patients with an SEPS were dysphagia-free after a median follow-up of 385 days (range, 77–924 days). Ten (50%) developed recurrent dysphagia. Major complications occurred in 2 patients (10%; 1 with hemorrhage and 1 with perforation). Six patients (33%) with a biodegradable stent were dysphagia-free after a median follow-up of 166 days (range 21–559 days) ( P = .83 compared with SEPS). Twelve patients (67%) had recurrent dysphagia. Major complications occurred in 4 patients (22%; 2 with hemorrhage, 2 with severe retrosternal pain) with a biodegradable stent ( P = .30 compared with SEPS). Reinterventions were less frequently indicated after biodegradeble stent than after SEPS placement (15 [mean, 0.8 ± 0.6 per stent placed] vs 21 [mean, 1.3 ± 0.4 per stent placed], respectively; P = .03). Conclusions Placement of SEPSs or biodegradable stents provides long-term relief of dysphagia in 30% and 33%, respectively, of patients with RBES. Biodegradable stents require fewer procedures than SEPSs, offering an advantage. Although stent placement is a viable strategy in patients with RBES, the ideal strategy still needs to be defined.