Clinical remission following endoscopic placement of retrievable, fully covered metal stents in patients with esophageal achalasia

Abstract

Metal stents may represent an alternative therapy in the treatment of achalasia. We therefore evaluated the effectiveness of retrievable, fully covered metal stents in patients with achalasia. Fifty-nine patients with achalasia were treated with retrievable, fully covered metal stents. Symptoms using a global symptom score (0-10), lower esophageal sphincter (LES) resting pressure, LES relaxation, and simultaneous contraction of the esophagus were analyzed before and 1 week and 1 month after intervention. Complications and treatment outcomes were followed up at 6, 12, 18, and 24 months postoperatively. Stent placement was successful, and clinical symptoms resolved (P < 0.01) in all patients. Regurgitation, dysphagia and chest pain improved significantly (all P < 0.01). Therapy improved LES resting pressure (51.4 ± 9.7 mmHg pretherapy vs. 20.9 ± 8.1 mmHg post-therapy), LES relaxation (58.1 ± 17.1% pretherapy vs. 84.5 ± 18.9% post-therapy), and simultaneous contraction of the esophagus (36.1 ± 8.6% pretherapy vs. 69.4 ± 23.1% post-therapy) 1 month after stent placement (all P < 0.01). The cumulative clinical remission rates 6, 12, 18, 24, 30, and 36 months after stent removal were 90.9%, 81.8%, 76.4%, 69.1%, 65.5%, and 49.1%, respectively. All patients tolerated stent placement. Twelve patients (25.5%) complained of substernal pain and five (10.6%) had substernal burning. Stents migrated in four patients (8.5%). Insertion of retrievable, fully covered metal stents is an effective and safe treatment in patients with achalasia.

Use of Fully Covered Self-Expandable Metal Stents for Benign Esophageal Disorders in Children

“…In adults the application of stents in patients with achalasia has been reported as an alternative, effective, safe method of treatment. 16,17 However, in this regard we are not aware of any studies related to the pediatric population.…”

European guidelines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations

“…91,92 On the other hand, as the risk and complexity of oesophageal resection increases with the deterioration of a patient's condition and nutritional status, end-stage achalasia should be carefully followed up to identify promptly when oesophagectomy is necessary. Several studies have investigated the use of alternative therapies such as oesophageal stents [93][94][95][96][97][98][99][100][101] and intrasphincteric injection with ethanolamine oleate in achalasia treatment. [102][103][104][105] Overall, there is no high-quality evidence to support that either of these therapies is effective for symptom relief in achalasia patients.…”

Achalasia: current treatment options

“…Over the last 15 years, some studies evaluated the efficacy and safety of the procedure [68][69][70][71], and some comparative trials versus PD are also available [72][73][74]. A variety of stent models have been used in the published series: differences included mesh design, presence of a covering and diameter.…”

“…Three Chinese studies including a large number of patients have been recently published [68,70,71]. Zhao et al [71] reported on 75 patients treated with a 30 mm partially covered SEMS for 3-7 days.…”

“…Zeng et al [68] Some small case series have been published also by few Western centers [69,75]. In 2001, De Palma et al [75] reported on eight patients treated with Nitinol coil stents and covered Ultraflex stents.…”