A comparison of the temporary placement of 3 different self-expanding stents for the treatment of refractory benign esophageal strictures: a prospective multicentre study

BMC Gastroenterol. 2012 Jun 12;12:70. doi: 10.1186/1471-230X-12-70.

Abstract

Background: Refractory benign esophageal strictures (RBESs) have been treated with the temporary placement of different self-expanding stents with conflicting results. We compared the clinical effectiveness of 3 types of stents: self-expanding plastic stents (SEPSs), biodegradable stents, and fully covered self-expanding metal stents (FCSEMSs), for the treatment of RBES.

Methods: This study prospectively evaluated 3 groups of 30 consecutive patients with RBESs who underwent temporary placement of either SEPSs (12 weeks, n = 10), biodegradable stents (n = 10) or FCSEMSs (12 weeks, n = 10). Data were collected to analyze the technical success and clinical outcome of the stents as evaluated by recurrent dysphagia, complications and reinterventions.

Results: Stent implantation was technically successful in all patients. Migration occurred in 11 patients: 6 (60%) in the SEPS group, 2 (20%) in the biodegradable group and 3 (30%) in the FCSEMS group (P = 0.16). A total of 8/30 patients (26.6%) were dysphagia-free after the end of follow-up: 1 (10%) in the SEPS group, 3 (30%) in the biodegradable group and 4 (40%) in the FCSEMS group (P = 0.27). More reinterventions were required in the SEPS group (n = 24) than in the biodegradable group (n = 13) or the FCSEMS group (n = 13) (P = 0.24). Multivariate analysis showed that stricture length was significantly associated with higher recurrence rates after temporary stent placement (HR = 1.37; 95% CI = 1.08-1.75; P = 0.011).

Conclusions: Temporary placement of a biodegradable stent or of a FCSEMS in patients with RBES may lead to long-term relief of dysphagia in 30 and 40% of patients, respectively. The use of SEPSs seems least preferable, as they are associated with frequent stent migration, more reinterventions and few cases of long-term improvement. Additionally, longer strictures were associated with a higher risk of recurrence.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Absorbable Implants* / adverse effects
  • Adult
  • Aged
  • Deglutition Disorders / epidemiology
  • Endoscopy / instrumentation
  • Endoscopy / methods*
  • Esophageal Stenosis / therapy*
  • Female
  • Foreign-Body Migration / epidemiology
  • Humans
  • Incidence
  • Male
  • Metals* / adverse effects
  • Middle Aged
  • Multivariate Analysis
  • Plastics* / adverse effects
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Stents* / adverse effects
  • Treatment Outcome

Substances

  • Metals
  • Plastics