Role of Esophageal Stents in Benign and Malignant Diseases

Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri 64128-2295, USA.
The American Journal of Gastroenterology (Impact Factor: 10.76). 12/2009; 105(2):258-73; quiz 274. DOI: 10.1038/ajg.2009.684
Source: PubMed


These recommendations provide an evidence-based approach to the role of esophageal stents in the management of benign and malignant diseases. These guidelines have been developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the Board of Trustees. The following guidelines are based on a critical review of the available scientific literature on the topic identified in Medline and PubMed (January 1992-December 2008) using search terms that included stents, self-expandable metal stents, self-expandable plastic stents, esophageal cancer, esophageal adenocarcinoma, esophageal squamous cell carcinoma, esophageal stricture, perforations, anastomotic leaks, tracheoesophageal fistula, and achalasia. These guidelines are intended for use by health-care providers and apply to adult, but not pediatric, patients. As with other practice guidelines, these guidelines are not intended to replace clinical judgment but rather to provide general guidelines applicable to the majority of patients. Clinicians need to integrate recommendations with their own clinical judgment, and with individual patient circumstances, values, and preferences. They are intended to be flexible, in contrast to standards of care, which are inflexible policies designed to be followed in every case. Specific recommendations are based on relevant published information. The quality of evidence and strength of recommendations have been assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, which is a system that has been adopted by multiple national and international societies. The GRADE system is based on a sequential assessment of quality of evidence, followed by assessment of the balance between benefits vs. downsides (harms, burden, and costs) and subsequent judgment regarding the strength of recommendation.

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    • "Stent-related morbidity in this study was found in five patients (33%), which is relatively low compared with other series (46–72%).[1011] Three patients had unsuccessful functional sealing with stent migration and two had serious tracheoesophageal fistulae. "
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    ABSTRACT: Background/Aim: Anastomotic leak after esophagectomy is one of the most challenging complications resulting in a high morbidity and mortality and prolonged hospitalization. The study intended to assess the outcome of endoluminal self-expanding stent in the treatment of this problem. Settings and Design: Department of Thoracic and Cardiovascular Surgery, Arhus University Hospital, Skejby, Arhus, Denmark. A retrospective study. Patients and Methods: From January 2007 to December 2010, 209 patients underwent esophagectomy for malignant disease of the esophagus or the cardia. Twenty patients developed anastomotic leak. Treatment consisted of conservative measures, surgery, and stent placement. Details of treatment, clinical outcome, complications, and mortality were evaluated. Statistical analysis: None. Results: One hundred and forty-seven patients (70.3%) had carcinoma of the cardia, whereas 62 patients (29.7%) had esophageal carcinoma. Twenty patients (9.5%) developed anastomotic leak; small (<1 cm) in two patients (10%); managed conservatively and bigger than 1 cm in 15 patients (75%); treated with an esophageal stent (Hanaro stent, DIAGMED Healthcare, Thirsk, YO7 3TD, United Kingdom). In three patients (15%), perforation of the staple line of the intrathoracic gastric conduit was found and managed by reoperation. Functional sealing of anastomoses after stent placement could be achieved in 10 patients (67%). Stent-related morbidity developed in five patients (33%): Migration of the stent, n=3 and tracheoesophageal fistula, n=2. Stents were smoothly removed 3 weeks after discharge. The mean hospital stay was 25 days. There was only one stent-related death (6.6%). Conclusion: Endoluminal stent implantation is an effective and safe option in the management of postesophagectomy leaks.
    Full-text · Article · Mar 2014 · Saudi Journal of Gastroenterology
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    • "In recent years, retrievable stent placement has evolved as a promising treatment for benign cardia stricture because of its well-distributed and more persistent dilation strength [5]. However, using available standard esophageal stents to treat benign cardia stricture often results in complications , including stent migration, insufficient dilation and reflux [6] [7]. Previously, the present authors' group developed a new retrievable cardia stent with an improved caliber and configuration , an anti-reflux valve and an acid-resistant coating to enhance its dilating force, stability, anti-reflux and anti-caustic effects, to make it uniquely suited for the treatment of benign cardia stricture (Scheme 1) [8] [9]. "
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    ABSTRACT: In benign esophageal strictures, the inflammation reaction and tissue hyperplasia after stent placement greatly limit the stent retention time and subsequent scar formation, which becomes one of the main reasons to influence the long-term recurrence rate. A newly developed biodegradable electrospun drug-fibers coated stent (DFCS) was expected to be fabricated to inhibit inflammation and scar formation. The electrospun paclitaxel/poly(ε-caprolactone) (PCL) fibers integrally covered on the bare stent using rotating collection method. The paclitaxel entrapment did not significantly affect the physical properties of electrospun PCL fibrous membranes. The mechanical results demonstrated that electrospun fibers containing paclitaxel covered on the stent maintained original mechanical characteristics of the stent, and no membrane tearing or ablation were observed after hundreds of repeated compressions. Paclitaxel release profiles were mainly controlled via diffusion of drug through the drug content, and stable release of paclitaxel continued up to 32 days at pH 4.0. Higher inhibition smooth muscle cells proliferation rates were observed on fibrous membranes with higher paclitaxel content. DFCS showed significant decrease in tissue inflammation and collagen fibre proliferation, and was easily removed from esophageal part which had nearly no damages to the tissues in dog model. Therefore, DFCS may be a great potential to markedly attenuate stent-induced inflammation and scar formation in the esophageal stenosis therapy.
    Full-text · Article · Jun 2013 · Acta biomaterialia
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    • "Many ES types exist but expandable ES, covered or not, are less dangerous to place than non-expandable ones [2], especially those containing nitinol [4]. In the management of BERF expandable covered ES are used but placement and post-placement phases are not danger-less [6] particularly in this context of post-CRT spontaneous BERF because complications seems more frequent [7] (increase risk of bleeding, esophageal perforation and death of the patient) even if some authors disagree, especially Raijmann et al [3, 8]. "
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    ABSTRACT: Benign esophagorespiratory fistula is a rare but often lethal affection and difficult to cure. Possible treatments are surgery or esophageal stenting but may fail and cause respiratory failure. Two patients with spontaneous esophagorespiratory fistula after chemoradiotherapy for an esophageal malignancy were both treated by esophageal exclusion but esophageal stent were left in place. The esophageal stents were transtracheally removed through the fistula. The removals were successful, patients could leave Intensive Care Unit and returned home. Transtracheal esophageal stent removal is technically possible but very risky. Such situations must be avoided: esophageal stents must absolutely be removed before esophageal exclusion.
    Full-text · Article · Apr 2013 · Journal of Clinical Medicine Research
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