Dilation of Benign Strictures in the Esophagus and Colon with the Polyflex Stent: A Case Series Study

Abstract

Polyflex, a new self-expanding plastic stent (SEPS), is increasingly used to treat obstructions in the gastrointestinal tract. The majority of reports on Polyflex come from tertiary referral centers. This retrospective study describes the efficacy and safety of this new SEPS for the treatment of benign strictures in esophagus and colon and its use in a community hospital. Seven patients were treated from August 2003 through December 2006. All of them presented with severe strictures, and were treated with Polyflex insertion. Four patients had esophageal obstructions (three peptic, one postoperative) and the remaining three patients had postoperative strictures in the rectosigmoid. One patient had a coexisting fistula. Two strictures (one esophageal and another colonic, both postoperative) received the Polyflex as the first line of treatment, without previous sessions of dilation. Esophageal strictures were solved after several consecutive SEPS insertions. Migrated stents were easily extracted from the stomach. On the other hand, colonic strictures achieved permanent dilation with a single stent. The patient with coexisting stricture and fistula became asymptomatic and still had the SEPS in place after four months. The one complication was mild pain after insertion. Polyflex seems to be a useful tool in the dilation of severe benign strictures in esophagus and rectosigmoid and, as in large centers, good results are achieved in a community hospital.

Dilation of refractory benign esophageal strictures

“…half of patients in 7 series, [48][49][50][51][52][53][54]56 and in almost two-thirds of procedures in the remaining series. 55 This high migration rate is likely the result of the fully covered stent design, the smooth outer surface of the stent, and the insufficient anchoring support provided by the stricture.…”

“…During the last 5 years, 8 studies have reported on more than 150 patients treated with a Polyflex stent for (refractory) benign esophageal strictures ( Table 2). [48][49][50][51][52][53][54][55][56] Indications for stent placement in these series included anastomotic strictures, followed by peptic strictures, caustic strictures, postradiation strictures, and some other causes.…”

“…55,56 An advantage of Polyflex stents is that they are easily removable. In addition, hyperplastic tissue overgrowth is unusual after Polyflex stent [48][49][50][51][52][53][54]56 This is probably because of the nonmetal material used, the fully covered design, and the relatively low radial force at the stent ends. On the other hand, migration rates were high after Polyflex stent placement, occurring in almost Table 3.…”

Comparative study of balloon and metal olive dilators for endoscopic management of benign anastomotic rectal strictures: clinical and cost-effectiveness outcomes

“…A wide range of endoscopic techniques have been used to treat postoperative colonic strictures, including mechanical dilation by means of expanding radial balloon dilators or fixed-diameter push-type dilators, electroincision or Nd-YAG laser stricturotomy in combination with balloon dilation [14][15][16], and more recently temporary insertion of self-expandable metal or plastic stents [17][18][19][20].…”

Enteral stents

“…67 There are very limited data on the use of esophageal SEPSs for the management of colonic strictures. 68 In a report of 3 patients with benign postoperative strictures at the rectosigmoid junction or the sigmoid colon, the placement of esophageal SEPS yielded resolution of strictures and/or symptoms in all patients. In another report of 21 patients with benign colonic strictures, SEMS placement yielded clinical success in 76% with a complication rate of 42%, a majority of which occurred in patients with diverticular strictures.…”