Expandable Polyester Silicon-Covered Stent for Malignant Esophageal Structures before Neoadjuvant Chemoradiation: A Pilot Study

Abstract

Patients with resectable esophageal cancer often require placement of a surgical jejunostomy tube prior to receiving chemoradiation so as to maintain adequate nutrition due to their inability to swallow and eat. This study reports a single institutional experience with the Polyflex self-expanding silicone stent (Riisch; Kernen. Germany) in patients with malignant stenosis receiving chemoradiation prior to esophagectomy. This was a retrospective, nonrandomized study of 6 patients who underwent Polyflex esophageal stent placement across a malignant stricture prior to receiving neoadjuvant chemoradiation. The study assessed procedural success, restoration of oral nutrition, migration, and removal of the Polyflex stent. The outcomes measured were the efficacy of treatment, stent-related complications, and changes in the nutritional status of the patient after stent placement. Stent placement was successful in 5 of 6 patients (83%). Restoration of oral nutrition after stent placement occurred in 5 of 5 patients (100%). Migration of the stent into the stomach occurred in 3 patients (60%) without occurrence of gastric outlet obstruction; there was no proximal migration. Stents were successfully removed endoscopically or at the time of esophagectomy. This early experience suggests that the removable silicone Polyflex stent is an effective alternative to a surgical jejunostomy tube for the management of malignant esophageal stenosis in patients for whom neoadjuvant chemoradiation is planned prior to esophagectomy.

The use of biodegradable (SX-ELLA) oesophageal stents to treat dysphagia due to benign and malignant oesophageal disease

“…In addition, nasoenteral or surgical feeding tubes serve as a constant reminder to the patient of their disease and impact significantly on quality-of-life measures [21]. SEMS have been used; however, the downstaging of chemotherapy makes migration highly likely and they may require endoscopic or surgical removal [22]. Also, at the time of surgery, SEMS can potentially make the resection of the oesophagus and assessment of the primary tumour more difficult [23].…”

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

“…Polyflex, a self-expanding plastic stent (SEPS), was first manufactured several years ago [6][7][8]. This stent has proven to be easily removable, even after being in place for long periods, suggesting that Polyflex could be a useful tool for refractory BGIS.…”

Nutritional management during neoadjuvant therapy for esophageal cancer

“…Many patients that are able to eat upon initial presentation will eventually require supplementation during the course of neoadjuvant therapy [11,42]. As a result some centers advocate routine feeding tube placement in all patients undergoing multimodal therapy [43,44].…”