Self-expanding plastic stents for benign esophageal lesions

• Published in: Gastrointestinal endoscopy 2004-12, Vol.60 (6), p.894-900
• Main Authors: Evrard, Sylvie, Le Moine, Olivier, Lazaraki, Giorgia, Dormann, Arno, Nakadi, Issam El, Devière, Jacques
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Burns, Chemical - diagnostic imaging; Burns, Chemical - etiology; Burns, Chemical - therapy; Caustics; Child, Preschool; Device Removal; Esophageal Diseases - diagnostic imaging; Esophageal Diseases - etiology; Esophageal Diseases - therapy; Esophageal Stenosis - diagnostic imaging; Esophageal Stenosis - etiology; Esophageal Stenosis - therapy; Esophagoscopy; Esophagus; Esophagus - injuries; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Medical sciences; Metals; Middle Aged; Plastics; Radiography; Retreatment; Stents; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Wound Healing - physiology
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(04)02278-3

A benign condition is a relative contraindication to the use of self-expanding metallic stents, because these devices usually are not retrievable. The self-expanding plastic stent is removable and induces less tissue hyperplasia. This study prospectively evaluated the use of a self-expanding plastic stent to treat benign esophageal conditions. Over 4 years, 21 patients underwent self-expanding plastic stent placement for various benign esophageal disorders, including refractory peptic (n = 2), caustic (n = 3), post-radiotherapy (n = 3), and anastomotic (n = 4) stenoses; hyperplastic (n = 5) stenosis within a previously implanted metallic stent; and anastomotic leak (n = 4) after esophagectomy. The self-expanding plastic stent was removed from all patients. Patients were followed for at least 8 months after stent removal. Implantation was successful in all cases. Temporary self-expanding plastic stent placement was curative in 17/21 patients, especially those with caustic and hyperplastic strictures and anastomotic fistula, all of which were treated successfully without re-intervention. Median follow-up was 21 months (range 8-39 months) after stent removal. Moreover, by inducing tissue ischemia, self-expanding plastic stent allowed delayed removal of metallic stents. Only one severe complication (tracheal compression) was encountered, and this resolved after stent removal. A range of benign stenosing disorders of the esophagus can be treated safely with a self-expanding plastic stent. Because the long-term results were highly favorable, self-expanding plastic stent placement could be used as the initial treatment for various conditions. Self-expanding plastic stent insertion within an esophageal self-expanding metallic stent allowed removal of the latter, theoretically unretrievable, stent.