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

Abstract

BackgroundRefractory 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.MethodsThis 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.ResultsStent 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).ConclusionsTemporary 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.

Utilising Oesophageal Biodegradable Stent in Benign Pyloric Stenosis: Novel Technique

“…Therefore, elective removal of the stent within four weeks of placement was recommended. Three studies [10,14,15] has been published showing the outcome of Ella esophageal BD stent since it became available to use in 2007, all these studies showed technical success rate of 100%, clinical success rate 30% [14] -100% [10,15] and migration rate 9% [10] -20% [14].…”

Endoscopy

“…Post-operative length of stay was a median of 1 (range 1 to 5) d following successful colonoscopic resection, and uncomplicated except for post-polypectomy syndrome and urinary retention in two patients. Amongst patients requiring surgical resection, length of stay was longer (median 5.5 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] d, p = 0.001, Mann Whitney), with four patients suffering from complications (anastomotic leak, an intra-abdominal fluid collection managed conservatively, urinary retention, and sepsis without identified source, respectively). Conclusions: LACE is an effective strategy, enabling safe and complete polypectomy for lesions that are difficult to access or resect at primary colonoscopy in about half of carefully selected patients.…”

“…ClinicalTrials.gov NCT01368289. Gastroenterology and Hepatology, Epworth Hospital, Melbourne, Victoria, Australia,5 Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Adelaide, South Australia, Australia,6 Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia,7 Department of Gastroenterology and Hepatology, Western Hospital, Melbourne, Victoria, Australia, 8 The Queensland Institute of Medical Research, Brisbane, Australia, Envoi Specialist Pathologists, Brisbane, Australia, 9 Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia Background and aims: Traditional serrated adenomas (TSAs) are part of the group of serrated colorectal polyps and represent 1.5% of all colorectal lesions. Serrated polyps ≥1 cm are associated with synchronous colorectal carcinoma.…”

Treatment of Esophageal Strictures with Savary-Guilliard Bougies

“…Success rates of these treatments are 80-90%, but 30-60% of patients develop dysphagia in long term follow-up and needs dilatation again. Recurrence rate is higher in complex strictures and with the increased number of sessions complication rate will also be higher 4,8 . There are three types of dilatators: Mercuryweighted bougies (i.e.…”

“…Endoscopic dilatation is the basic treatment option and SGD is the choice of treatment. SGD may be performed with or without fluoroscopy 1,3,4 . 80-90% of patients can be treated by SGD or balloon dilatation but these may be insufficient may recur in some of the patients.…”