Clinical outcomes following stent placement in refractory benign esophageal stricture: a systematic review and meta-analysis

Fuccio, Lorenzo; Hassan, Cesare; Frazzoni, Leonardo; Miglio, Rossella; Repici, Alessandro

doi:10.1055/s-0034-1393331

Cited by 92 publications

(102 citation statements)

References 20 publications

(38 reference statements)

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“…No major complications, including massive bleeding, perforation or fatal infection were observed. Conversely to previous studies (27,28), no migration of the stents were observed in the present study. This may be due to the fact that stents with larger diameters were used, which enhanced the radical focus of the esophagus.…”

Section: Discussioncontrasting

confidence: 99%

Effect of a paclitaxel-eluting metallic stent on rabbit esophagus

Yin¹,

Gao²,

Chen³

et al. 2016

Experimental and Therapeutic Medicine

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The use of self-expanding metallic stents (SEMS) is the current treatment of choice for malignant gastrointestinal obstructions. A paclitaxel-eluting metallic SEMS (PEMS) may have an antitumor effect on esophageal tissue. PEMS with 10% paclitaxel or conventional SEMS were inserted into the lower esophagus of rabbits. Following the insertion of the stents for 1, 2, 4 and 6 weeks, the rabbits were sacrificed and the status of the stent insertion was examined, as well as any macroscopic or microscopic mucosal changes in the esophageal tissue. All the rabbits survived until death without any complications. No migration following stent insertion occurred. The number of cases with proximal obstruction increased in a time-dependent manner, and no significant difference was observed between the two groups. Gross histological examination showed similar tissue reaction to the stents at 1, 2 and 4 weeks, and inflammatory cell infiltrating was higher in the SEMS group at 1 and 2 weeks. However, inflammatory cell infiltration was markedly higher in the PEMS group at 4 and 6 weeks. Food-intake and weight were similar in the two groups. The results of the present study demonstrated that PEMS may serve as a safe alternative treatment strategy for esophageal obstruction. Furthermore, PEMS may inhibit the tumor growth of the esophageal wall through inflammatory infiltration and targeted drug delivery. A tumor model will be required in the future for evaluating the prognosis of patients with advanced esophageal carcinoma.

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Section: Discussioncontrasting

confidence: 99%

Effect of a paclitaxel-eluting metallic stent on rabbit esophagus

Yin¹,

Gao²,

Chen³

et al. 2016

Experimental and Therapeutic Medicine

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“…EBD should have been considered before the esophageal stricture progressed to obstruction. Though an esophageal stent have been reported to be useful for refractory benign esophageal stricture [14, 15], there is a report that an esophageal stent placement itself can be a risk factor related to AEN [16], and no report about successful stent placement for esophageal stricture after AEN. Therefore, stent treatment for esophageal stricture after AEN still remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Successful bypass operation for esophageal obstruction after acute esophageal necrosis: a case report

et al. 2017

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BackgroundAcute esophageal necrosis (AEN) is a rare clinical disorder. Esophageal stenosis or obstruction is one of severe complications, but there are a few reports about surgical treatments. In such a situation, it still remains controversial which to choose, esophagectomy or bypass operation.Case presentationA 61-year-old woman was admitted to the local hospital for septic shock with diabetic ketoacidosis due to necrotizing fasciitis of the right thigh. Three days later, she had hematemesis, and gastrointestinal endoscopy revealed black mucosal coloration throughout the entire esophagus. She was diagnosed as having AEN. Her general condition improved after intensive care, debridement, and treatment with antibiotics and a proton pump inhibitor; the esophageal mucosal color recovered. However, an esophageal stricture developed after 1 month, and the patient underwent gastrostomy to remove an esophageal obstruction after 3 months. She was referred to our hospital for surgical treatment 1 year and 4 months after the occurrence of AEN because of her strong desire for oral intake. Her medical condition was poor, and she could not walk due to generalized muscle weakness. After rehabilitation for 8 months, we performed an esophageal bypass using a gastric conduit via the percutaneous route rather than esophagectomy because of her multiple severe comorbidities including walking difficulty, chronic hepatitis C, cerebrovascular disease, and chronic renal failure. Minor leakage of the esophagogastrostomy occurred and was resolved with conservative treatment. The patient began oral intake on postoperative day 34 and was discharged on day 52.ConclusionEsophageal obstruction after AEN was successfully treated by esophageal bypass using a gastric conduit in a high-risk patient. Because the majority of patients with AEN have multiple severe comorbidities, assessing the medical condition of the patient adequately is important prior to choosing either an esophagectomy or bypass surgery.

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“…Clinical trials assessing the efficacy of FCSEMS and SEPS had suboptimal long-term outcomes. A recent meta-analysis 8 regarding the treatment efficacy of FCSEMS, SEPS and BD stents in refractory benign strictures, found an overall clinical success rate of 40.5 % when all treatment modalities were considered. The differences in the success rates between the various modalities were not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to these, the optimal injection technique as well as the frequency and dose of steroids to be used are yet to be established 5. Removable plastic (SEPS) or fully covered metal self-expanding stents (FCSEMS) have also been tried, but initial positive results were not replicated 6 7 and a recent meta-analysis reported significant migration rates and mediocre success rates overall 8. …”

Section: Introductionmentioning

confidence: 99%

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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Clinical outcomes following stent placement in refractory benign esophageal stricture: a systematic review and meta-analysis

Abstract: Background

Cited by 92 publications

References 20 publications

Effect of a paclitaxel-eluting metallic stent on rabbit esophagus

Effect of a paclitaxel-eluting metallic stent on rabbit esophagus

Successful bypass operation for esophageal obstruction after acute esophageal necrosis: a case report

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

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