The Use of Biodegradable Stents in Malignant Oesophageal Strictures for the Treatment of Dysphagia Before Neoadjuvant Treatment or Radical Radiotherapy: A Feasibility Study

• Published in: Cardiovascular and interventional radiology 2013-08, Vol.36 (4), p.1047-1054
• Main Authors: Krokidis, Miltiadis, Burke, Chris, Spiliopoulos, Stavros, Gkoutzios, Panos, Hynes, Orla, Ahmed, Irfan, Dourado, Renato, Sabharwal, Tarun, Mason, Robert, Adam, Andreas
• Format: Article
• Language: English
• Subjects: Absorbable Implants; Aged; Biodegradability; Cardiology; Clinical Investigation; Combined Modality Therapy; Deglutition Disorders - etiology; Deglutition Disorders - pathology; Deglutition Disorders - therapy; Esophageal Neoplasms - complications; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophageal Stenosis - etiology; Esophageal Stenosis - mortality; Esophageal Stenosis - pathology; Esophageal Stenosis - therapy; Esophagoscopy - methods; FEASIBILITY STUDIES; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Imaging; INCLUSIONS; INFLAMMATION; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy - methods; Nuclear Medicine; NUTRITION; Palliative Care - methods; PATIENTS; Polydioxanone; Prospective Studies; Prosthesis Design; Quality of Life; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy, High-Energy - methods; Risk Assessment; Stents; SURGERY; Survival Rate; Treatment Outcome; Ultrasound
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-012-0503-0

Purpose To evaluate the clinical results of the use of biodegradable oesophageal stents in malignant strictures. Methods Eleven patients were included in this prospective analysis in which a woven polydioxanone biodegradable oesophageal stent was used. The inclusion criterion was that the patient underwent neoadjuvant treatment or radical radiotherapy after the stent insertion. Primary end points were dysphagia score at discharge, stent patency, and complication rate. Secondary end points were overall survival and surgical outcome of surgery. Results There was a 100 % procedure technical success rate. Early complications occurred in three patients resulting in failure to restore oral nutrition. In the remaining eight patients, dysphagia was significantly improved at discharge. Mean stent patency rate in this group was 71.5 days. Stent dysfunction occurred in five of eight patients (62.5 %); in two of five patients this was due to local inflammatory reaction, and in three of five patients it was due to tumour growth after a mean time of 97.8 days, and a new metallic stent was consequently placed in four of five patients. One patient was successfully treated with esophagectomy. At the end of follow-up (mean time 102.1 days), three of eight stents were patent. The overall patient survival rate was 81.8 %. Conclusion Although short-term dysphagia scores improved, biodegradable stents do not appear to offer a clear beneficial effect in most cases of malignant strictures, particularly due to a local inflammatory reaction that may be induced. Technical improvement of the device and delineation of the patient group that would benefit from its use is necessary if further studies are to be conducted in the future.