Use of a fully covered self-expandable metal stent for the treatment of benign esophageal diseases

• Published in: Gastrointestinal endoscopy 2010-10, Vol.72 (4), p.712-720
• Main Authors: Bakken, Johan C., MD, Wong Kee Song, Louis M., MD, de Groen, Piet C., MD, Baron, Todd H., MD, FASGE
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Digestive system. Abdomen; Endoscopy; Esophageal Diseases - therapy; Esophageal Fistula - therapy; Esophageal Perforation - etiology; Esophageal Stenosis - etiology; Esophageal Stenosis - therapy; Female; Foreign-Body Migration - therapy; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal Reflux - complications; Humans; Intention to Treat Analysis; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Prosthesis Design; Retrospective Studies; Stents; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2010.06.028

Background Fully covered self-expandable metal stents (FCSEMSs) have been proposed for the treatment of benign esophageal diseases. Objective To review our experience with FCSEMSs in patients with benign esophageal diseases. Design Retrospective case review of patients who underwent FCSEMS placement for benign esophageal diseases, including (1) benign strictures from GERD—caustic and idiopathic causes, (2) radiation-induced strictures, (3) anastomotic strictures, (4) esophageal fistulae/leaks, and (5) esophageal perforations. Setting Tertiary-care medical center. Patients This study involved 37 male and 19 female patients (average age 60 years, range 25-94 years) who underwent FCSEMS placement. Intervention FCSEMS placement. Main Outcome Measurements Technical success with stent placement and removal, stent migration, long-term and short-term complications, and treatment success according to clinical symptoms, follow-up endoscopy, or imaging. Results Stent placement was successful in 100 of 107 (93%) procedures, with a total of 104 stents placed. Migration was noted in 37 of 104 (35.6%) stents and was seen more frequently with proximal stents and stents placed for anastomotic strictures. Initial treatment success was seen in 56% of patients with any stricture and in 38% of patients with a fistula/leak or perforation, although data to document long-term resolution were lacking. Limitations This was a retrospective review with patients selected from a tertiary-care medical center. Two endoscopists performed the majority of procedures. Conclusion Temporary placement of FCSEMSs for benign esophageal diseases has moderate clinical efficacy and is limited by stent migration. Removability was easily demonstrated. Newer developments in stent design may improve clinical outcomes for these patients.