Selective application of fully covered biliary stents and narrow-diameter esophageal stents for proximal esophageal indications

Abstract

Background Proximal esophageal stents are poorly tolerated and have a high risk of complications. We report our experience using fully covered, biliary, self-expandable metal stents (B-SEMS) and narrow-diameter, esophageal, self-expandable metal stents (NDE-SEMS) for this group of patients.

Methods 24 patients underwent placement of B-SEMS or NDE-SEMS for proximal esophageal lesions between 1 January 2011 and 31 July 2016. The outcomes included improvement of dysphagia, healing of fistulas, and adverse events.

Results 10 patients received B-SEMS and 14 had NDE-SEMS. Median follow-up time was 11.5 months (range 0.5 – 62 months). In both cohorts, stents were left in place for a mean of 6 weeks. The dysphagia score decreased in 7 (70 %) and 10 (71.4 %) patients, and fistulas resolved in 3/5 (60.0 %) and 5/8 (62.5 %) patients with B-SEMS and NDE-SEMS, respectively. Stent migration occurred in three patients (30.0 %) with B-SEMS and five patients (35.7 %) with NDE-SEMS.

Conclusions Both stents were well tolerated and resulted in overall improvement of dysphagia in 70.8 % of patients. B-SEMS appeared to be more favorable for cervical esophageal lesions with narrower diameters, while NDE-SEMS may be better for more distal lesions.

• References

• 1 Brandimarte G, Tursi A. Endoscopic treatment of benign anastomotic esophageal stenosis with electrocautery. Endoscopy 2002; 34: 399-401
• 2 de Wijkerslooth LR, Vleggaar FP, Siersema PD. Endoscopic management of difficult or recurrent esophageal strictures. Am J Gastroenterol 2011; 106: 2080-2091
• 3 Hagiwara A, Togawa T, Yamasaki J. et al. Endoscopic incision and balloon dilatation for cicatricial anastomotic strictures. Hepatogastroenterology 1999; 46: 997-999
• 4 Hirdes MM, van Hooft JE, Koornstra JJ. et al. Endoscopic corticosteroid injections do not reduce dysphagia after endoscopic dilation therapy in patients with benign esophagogastric anastomotic strictures. Clin Gastroenterol Hepatol 2013; 11: 795-801.e1
• 5 Lew RJ, Kochman ML. A review of endoscopic methods of esophageal dilation. J Clin Gastroenterol 2002; 35: 117-126
• 6 Choi EK, Song HY, Kim JW. et al. Covered metallic stent placement in the management of cervical esophageal strictures. J Vasc Interv Radiol 2007; 18: 888-895
• 7 Bethge N, Sommer A, Vakil N. A prospective trial of self-expanding metal stents in the palliation of malignant esophageal strictures near the upper esophageal sphincter. Gastrointest Endosc 1997; 45: 300-303
• 8 Eleftheriadis E, Kotzampassi K. Endoprosthesis implantation at the pharyngo-esophageal level: problems, limitations and challenges. World J Gastroenterol 2006; 12: 2103-2108
• 9 Fuccio L, Hassan C, Frazzoni L. et al. Clinical outcomes following stent placement in refractory benign esophageal stricture: a systematic review and meta-analysis. Endoscopy 2016; 48: 141-148
• 10 Gangloff A, Lecleire S, Di Fiore A. et al. Fully versus partially covered self-expandable metal stents in benign esophageal strictures. Dis Esophagus 2015; 28: 678-683
• 11 Verschuur EM, Kuipers EJ, Siersema PD. Esophageal stents for malignant strictures close to the upper esophageal sphincter. Gastrointest Endosc 2007; 66: 1082-1090
• 12 Atkinson M. Diseases of the alimentary system. Dysphagia. Br Med J 1977; 1: 91-93
• 13 Poincloux L, Sautel C, Rouquette O. et al. The clinical outcome in patients treated with a newly designed SEMS in cervical esophageal strictures and fistulas. J Clin Gastroenterol 2016; 50: 379-387