SEQUENTIAL BIODEGRADABLE STENTING IS EFFECTIVE AND SAFE FOR REFRACTORY BENIGN OESOPHAGEAL PEPTIC STRICTURES

Aims:

Refractory benign oesophageal strictures (RBES) unresponsive to potent acid-suppression are challenging to manage. Serial balloon dilation, self-expanding metal (SEMS)/plastic stents offer dysphagia-free success rates between 21 – 52%. Self-expanding biodegradable stents (BDS-SX-ELLA) have comparable efficacy with added benefit of not requiring removal. To date, 1 study has evaluated sequential stenting up to 3 stents with BDS for RBES. We assessed efficacy of serial BDS stenting for recurrent peptic strictures at District General Hospital setting.

Methods:

Retrospective review of patients (2011 – 15) undergoing serial BDS stenting for RBES, evaluating length of time between stents, additional procedures and complication rates.

Results:

4/16 patients (50 – 87 yo) requiring >/= 2 stents, underwent 22 day-case procedures, a median of 6 procedures (range 2 – 9), over a FU period of 817 days (116 – 1502). Each stent lasted a median duration of 126 days (54 – 467). The median number of days between stent-placement was 128 for first stent, (112 – 467), 153 days for second (98 – 154), 119 days for the third (104 – 140), and 141 days for the fourth (126 – 155). No serious complications were encountered. Minor transient complications observed in 4 procedures (18.1%) including chest pain (1) and vomiting (3). 1 technical failure (4.5%) required repeat BDS due to stent migration. An additional 21 OGDs were performed in the intervening period between stents – a median of 4.5 additional per patient (2 – 10). 7 of these were balloon dilations (33%), where symptoms did not correlate with a requirement to deploy further BDS on endoscopic assessment. 1 patient underwent all BDS with topical throat anaesthesia only.

Conclusions:

Sequential biodegradable stenting is well-tolerated and very safe alternative to repeated serial dilations for RBES. Used alone, or combined with intermittent dilations, BDS provides extended dysphagia relief. However, there is no accrued benefit in time to dysphagia recurrence with increasing numbers of BDS. Larger studies with longer follow-up may help establish long-term efficacy, safety and cost-effectiveness.