Clin Endosc.  2014 Jul;47(4):295-300. 10.5946/ce.2014.47.4.295.

Plastic and Biodegradable Stents for Complex and Refractory Benign Esophageal Strictures

Affiliations
  • 1Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea. doc0224@pusan.ac.kr

Abstract

Endoscopic stent placement is a well-accepted and effective alternative treatment modality for complex and refractory esophageal strictures. Among the currently available types of stents, the partially covered self-expanding metal stent (SEMS) has a firm anchoring effect, preventing stent migration and ensuring effective covering of a narrowed segment. However, hyperplastic tissue reaction driven by the uncovered mesh may prevent easy and safe stent removal. As an alternative, a fully covered SEMS decreases the recurrence of dysphagia caused by hyperplastic tissue ingrowth; however, it has a high migration rate. Likewise, although a self-expanding plastic stent (SEPS) reduces reactive hyperplasia, the long-term outcome is disappointing because of the high rate of stent migration. A biodegradable stent has the main benefit of not requiring stent removal in comparison with SEMS and SEPS. However, it still has a somewhat high rate of hyperplastic reaction, and the long-term outcome does not satisfy expectations. Up to now, the question of which type of stent should be recommended for the effective treatment of complex and refractory benign strictures has no clear answer. Therefore, the selection of stent type for endoscopic treatment should be individualized, taking into consideration the endoscopist's experience as well as patient and stricture characteristics.

Keyword

Stricture; Esophagus; Stents; Endoscopic treatment

MeSH Terms

Constriction, Pathologic*
Deglutition Disorders
Esophagus
Humans
Hyperplasia
Plastics*
Recurrence
Stents*
Plastics

Figure

  • Fig. 1 Stents currently used for benign esophageal strictures. (A)Niti-S covered stent (Taewoong Medical). (B) Polyflex stent (Boston Scientific). (C) ELLA-BD stent (ELLA-CS).


Reference

1. Siersema PD. Treatment options for esophageal strictures. Nat Clin Pract Gastroenterol Hepatol. 2008; 5:142–152. PMID: 18250638.
Article
2. Hirdes MM, Vleggaar FP, Siersema PD. Stent placement for esophageal strictures: an update. Expert Rev Med Devices. 2011; 8:733–755. PMID: 22029470.
Article
3. Repici A, Hassan C, Sharma P, Conio M, Siersema P. Systematic review: the role of self-expanding plastic stents for benign oesophageal strictures. Aliment Pharmacol Ther. 2010; 31:1268–1275. PMID: 20236257.
Article
4. Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc. 2005; 62:474–475. PMID: 16111985.
Article
5. Patterson DJ, Graham DY, Smith JL, et al. Natural history of benign esophageal stricture treated by dilatation. Gastroenterology. 1983; 85:346–350. PMID: 6862159.
Article
6. Spechler SJ. American gastroenterological association medical position statement on treatment of patients with dysphagia caused by benign disorders of the distal esophagus. Gastroenterology. 1999; 117:229–233. PMID: 10381932.
Article
7. Eloubeidi MA, Talreja JP, Lopes TL, Al-Awabdy BS, Shami VM, Kahaleh M. Success and complications associated with placement of fully covered removable self-expandable metal stents for benign esophageal diseases (with videos). Gastrointest Endosc. 2011; 73:673–681. PMID: 21272871.
Article
8. Holm AN, de la Mora Levy JG, Gostout CJ, Topazian MD, Baron TH. Self-expanding plastic stents in treatment of benign esophageal conditions. Gastrointest Endosc. 2008; 67:20–25. PMID: 17945227.
Article
9. Siersema PD, de Wijkerslooth LR. Dilation of refractory benign esophageal strictures. Gastrointest Endosc. 2009; 70:1000–1012. PMID: 19879408.
Article
10. Dua KS, Vleggaar FP, Santharam R, Siersema PD. Removable self-expanding plastic esophageal stent as a continuous, non-permanent dilator in treating refractory benign esophageal strictures: a prospective two-center study. Am J Gastroenterol. 2008; 103:2988–2994. PMID: 18786110.
Article
11. Kim JH, Song HY, Choi EK, Kim KR, Shin JH, Lim JO. Temporary metallic stent placement in the treatment of refractory benign esophageal strictures: results and factors associated with outcome in 55 patients. Eur Radiol. 2009; 19:384–390. PMID: 18726598.
Article
12. van Boeckel PG, Vleggaar FP, Siersema PD. A comparison of temporary self-expanding plastic and biodegradable stents for refractory benign esophageal strictures. Clin Gastroenterol Hepatol. 2011; 9:653–659. PMID: 21586341.
Article
13. Mercer CD, Hill LD. Surgical management of peptic esophageal stricture. Twenty-year experience. J Thorac Cardiovasc Surg. 1986; 91:371–378. PMID: 3951242.
14. Little AG, Naunheim KS, Ferguson MK, Skinner DB. Surgical management of esophageal strictures. Ann Thorac Surg. 1988; 45:144–147. PMID: 3341821.
Article
15. van Boeckel PG, Dua KS, Weusten BL, et al. Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks. BMC Gastroenterol. 2012; 12:19. PMID: 22375711.
Article
16. Verschuur EM, Repici A, Kuipers EJ, Steyerberg EW, Siersema PD. New design esophageal stents for the palliation of dysphagia from esophageal or gastric cardia cancer: a randomized trial. Am J Gastroenterol. 2008; 103:304–312. PMID: 17900325.
Article
17. Martin RC, Woodall C, Duvall R, Scoggins CR. The use of self-expanding silicone stents in esophagectomy strictures: less cost and more efficiency. Ann Thorac Surg. 2008; 86:436–440. PMID: 18640310.
Article
18. Pungpapong S, Raimondo M, Wallace MB, Woodward TA. Problematic esophageal stricture: an emerging indication for self-expandable silicone stents. Gastrointest Endosc. 2004; 60:842–845. PMID: 15557974.
Article
19. Conio M, Repici A, Battaglia G, et al. A randomized prospective comparison of self-expandable plastic stents and partially covered self-expandable metal stents in the palliation of malignant esophageal dysphagia. Am J Gastroenterol. 2007; 102:2667–2677. PMID: 18042102.
Article
20. Repici A, Conio M, De Angelis C, et al. Temporary placement of an expandable polyester silicone-covered stent for treatment of refractory benign esophageal strictures. Gastrointest Endosc. 2004; 60:513–519. PMID: 15472671.
Article
21. Repici A, Vleggaar FP, Hassan C, et al. Efficacy and safety of biodegradable stents for refractory benign esophageal strictures: the BEST (Biodegradable Esophageal Stent) study. Gastrointest Endosc. 2010; 72:927–934. PMID: 21034894.
Article
22. Thomas T, Abrams KR, Subramanian V, Mannath J, Ragunath K. Esophageal stents for benign refractory strictures: a meta-analysis. Endoscopy. 2011; 43:386–393. PMID: 21437850.
Article
23. Broto J, Asensio M, Vernet JM. Results of a new technique in the treatment of severe esophageal stenosis in children: poliflex stents. J Pediatr Gastroenterol Nutr. 2003; 37:203–206. PMID: 12883312.
Article
24. Evrard S, Le Moine O, Lazaraki G, Dormann A, El Nakadi I, Devière J. Self-expanding plastic stents for benign esophageal lesions. Gastrointest Endosc. 2004; 60:894–900. PMID: 15605003.
Article
25. Triester SL, Fleischer DE, Sharma VK. Failure of self-expanding plastic stents in treatment of refractory benign esophageal strictures. Endoscopy. 2006; 38:533–537. PMID: 16767594.
Article
26. Barthel JS, Kelley ST, Klapman JB. Management of persistent gastroesophageal anastomotic strictures with removable self-expandable polyester silicon-covered (Polyflex) stents: an alternative to serial dilation. Gastrointest Endosc. 2008; 67:546–552. PMID: 18294520.
Article
27. García-Cano J. Dilation of benign strictures in the esophagus and colon with the polyflex stent: a case series study. Dig Dis Sci. 2008; 53:341–346. PMID: 17565471.
Article
28. Karbowski M, Schembre D, Kozarek R, Ayub K, Low D. Polyflex self-expanding, removable plastic stents: assessment of treatment efficacy and safety in a variety of benign and malignant conditions of the esophagus. Surg Endosc. 2008; 22:1326–1333. PMID: 18027044.
Article
29. Oh YS, Kochman ML, Ahmad NA, Ginsberg GG. Clinical outcomes after self-expanding plastic stent placement for refractory benign esophageal strictures. Dig Dis Sci. 2010; 55:1344–1348. PMID: 20155322.
Article
30. Canena JM, Liberato MJ, Rio-Tinto RA, et al. A comparison of the temporary placement of 3 different self-expanding stents for the treatment of refractory benign esophageal strictures: a prospective multicentre study. BMC Gastroenterol. 2012; 12:70. PMID: 22691296.
Article
31. Stivaros SM, Williams LR, Senger C, Wilbraham L, Laasch HU. Woven polydioxanone biodegradable stents: a new treatment option for benign and malignant oesophageal strictures. Eur Radiol. 2010; 20:1069–1072. PMID: 19921200.
Article
32. Tanaka T, Takahashi M, Nitta N, et al. Newly developed biodegradable stents for benign gastrointestinal tract stenoses: a preliminary clinical trial. Digestion. 2006; 74:199–205. PMID: 17341853.
Article
33. Saito Y, Tanaka T, Andoh A, et al. Usefulness of biodegradable stents constructed of poly-l-lactic acid monofilaments in patients with benign esophageal stenosis. World J Gastroenterol. 2007; 13:3977–3980. PMID: 17663513.
Article
34. Saito Y, Tanaka T, Andoh A, et al. Novel biodegradable stents for benign esophageal strictures following endoscopic submucosal dissection. Dig Dis Sci. 2008; 53:330–333. PMID: 17713855.
Article
35. van Hooft JE, van Berge Henegouwen MI, Rauws EA, Bergman JJ, Busch OR, Fockens P. Endoscopic treatment of benign anastomotic esophagogastric strictures with a biodegradable stent. Gastrointest Endosc. 2011; 73:1043–1047. PMID: 21392754.
Article
36. Hair CS, Devonshire DA. Severe hyperplastic tissue stenosis of a novel biodegradable esophageal stent and subsequent successful management with high-pressure balloon dilation. Endoscopy. 2010; 42(Suppl 2):E132–E133. PMID: 20405380.
Article
37. Vandenplas Y, Hauser B, Devreker T, Urbain D, Reynaert H. A biodegradable esophageal stent in the treatment of a corrosive esophageal stenosis in a child. J Pediatr Gastroenterol Nutr. 2009; 49:254–257. PMID: 19561544.
Article
38. Orive-Calzada A, Alvarez-Rubio M, Romero-Izquierdo S, et al. Severe epithelial hyperplasia as a complication of a novel biodegradable stent. Endoscopy. 2009; 41(Suppl 2):E137–E138. PMID: 19544266.
Article
39. Hirdes MM, Siersema PD, van Boeckel PG, Vleggaar FP. Single and sequential biodegradable stent placement for refractory benign esophageal strictures: a prospective follow-up study. Endoscopy. 2012; 44:649–654. PMID: 22723182.
Article
40. Karakan T, Utku OG, Dorukoz O, et al. Biodegradable stents for caustic esophageal strictures: a new therapeutic approach. Dis Esophagus. 2013; 26:319–322. PMID: 22974043.
Article
41. Černá M, Köcher M, Válek V, et al. Covered biodegradable stent: new therapeutic option for the management of esophageal perforation or anastomotic leak. Cardiovasc Intervent Radiol. 2011; 34:1267–1271. PMID: 21213108.
Article
42. Zhu YQ, Cui WG, Cheng YS, Chang J, Chen NW, Yan L. Evaluation of biodegradable paclitaxel-eluting nanofibre-covered metal stents for the treatment of benign cardia stricture in an experimental model. Br J Surg. 2013; 100:784–793. PMID: 23553755.
Article
43. Zhu YQ, Cui WG, Cheng YS, et al. Biodegradable rapamycin-eluting nano-fiber membrane-covered metal stent placement to reduce fibroblast proliferation in experimental stricture in a canine model. Endoscopy. 2013; 45:458–468. PMID: 23580413.
Article
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