Comparison of a standard fully covered stent with a super‐thick silicone‐covered stent for the treatment of refractory esophageal benign strictures: A prospective multicenter study

Abstract

Background: Some esophageal strictures resist endoscopic treatments. There is a need for new treatments, such as specifically designed stents. Objective: Our study sought to compare the results achieved with a standard, fully covered metallic stent (FCMS) and those achieved using a stent designed specifically for benign strictures (BS-FCMS). Patients and methods: The study used a prospective, multicenter, controlled design, with patients recruited from tertiary referral centers. Patients with refractory esophageal strictures were included. Standard FCMS were used in group 1 (N ¼ 24), and BS-FCMS were used in group 2 (N ¼ 17). Patients were followed for 24 months after stent removal. The main outcomes measured were stricture resolution rate, 24 months' recurrence rate and stent-related morbidity. Results: Early stent migrations occurred in one (4.1%) patient from group 1 and five (29.4%) from group 2 (p < 0.05). During esophageal stenting, complications occurred in six patients (25%) in group 1 and six patients (35.3%) in group 2 (p ¼ 0.47), respectively. Fifty percent of complications were attributed to migration. There was no procedure-related morbidity associated with the extraction of the stent. The stricture resolution rate was, respectively, 95.2% in group 1 and 87.5% in group 2 (the difference between the two groups is not significant). During follow-up, stricture recurrence occurred in 15/19 patients (group 1, 79%) and 7/8 patients (group 2, 87.5%; p ¼ 1.0). The median time to recurrence of esophageal stricture was 1.7 months (group 1, 0.6-12 months) and 1 month (group 2, 0.1-6 months). Study limitations include its nonrandomized design. Conclusion: The stricture resolution rate was high at the end of the stenting period for both types of stents without any statistical difference between the two groups, but the long-term results were disappointing, with stricture recurring frequently and rapidly in both groups.

Systematic review: the prevention of oesophageal stricture after endoscopic resection

“…Nevertheless, the poor results of covered stents in the treatment of benign oesophageal strictures of any kind, and the absence of any anti‐proliferative or anti‐inflammatory/anti‐fibrotic effect of the stents—indeed, with a possible pro‐inflammatory action—make stenting an unlikely candidate for the title of best prophylactic method. Thus, the results from Weng et al .…”

“…Moreover, only patients who experienced stent migration developed a stricture. 114 Nevertheless, the poor results of covered stents in the treatment of benign oesophageal strictures of any kind, 115 and the absence of any anti-proliferative or antiinflammatory/anti-fibrotic effect of the stents-indeed, with a possible pro-inflammatory action-make stenting an unlikely candidate for the title of best prophylactic method. Thus, the results from Weng et al need to be confirmed in larger studies before oesophageal stent placement can be considered as a valid option to prevent stricture development.…”

Esophageal Stenting in Clinical Practice: an Overview

“…As for malignant dysphagia, but without formal FDA approval, fcSEMS have also been investigated in clinical trials treating RBES [ 46 – 48 ]. The clinical success rates of fcSEMS are likely to be comparable and not significantly different from SEPS and BDS [ 42 ], although this has never been investigated in head-to-head RCTs.…”

Novel Endoscopic Stent for Anastomotic Leaks after Total Gastrectomy Using an Anchoring Thread and Fully Covering Thick Membrane: Prevention of Embedding and Migration

“…The stent then becomes completely embedded into the esophageal mucosa by the 4th–6th week. Massive granulation tissue can result in partial esophageal stricture by the 8th week or later [ 16 ]. Various methods have been introduced to successfully remove stent in patients with embedded stent, such as stent-in-stent (SIS) technique, argon plasma coagulation, and the overtube technique [ 4 ].…”