Subscribe to RSS
DOI: 10.1055/s-0030-1256405
© Georg Thieme Verlag KG Stuttgart · New York
Biodegradable stents for the treatment of benign stenoses of the small and large intestines
Publication History
submitted 17 January 2011
accepted after revision 24 February 2011
Publication Date:
27 May 2011 (online)
Biodegradable stents, which are made of various synthetic polymers, such as polylactide or polyglycolide, or co-polymers, such as polydioxanone, can be used for the treatment of benign refractory stenoses of the gastrointestinal tract. Here we report 11 patients (median age 41) with stenosing Crohn’s disease of the small and/or large intestine. Endoscopic insertion of a biodegradable stent was successful at the first attempt in all patients except one. Subsequent follow-up was for a mean of 16 months, median 17 months, range 12 – 29 months. Early stent migration (between 2 days and 8 weeks) was seen in three patients. Mucosal overgrowth (epithelial hyperplasia) was not observed in any of the patients during the follow-up period. The high rate of early stent migration might be solved by appropriate tailoring and further improvements in the design of the biodegradable stents. Proof of long-term efficacy and safety requires further studies.
References
- 1 McLoughlin M T, Byrne M F. Endoscopic stenting – where we are now and where can we go?. World J Gastroenterol. 2008; 14 3798-3803
- 2 Siersema P D. Stenting for benign esophageal strictures. Endoscopy. 2009; 41 363-373
- 3 Chun H J, Kim E S, Hyun J J et al. Gastrointestinal and biliary stents. J Gastroenterol Hepatol. 2010; 25 234-243
- 4 Freeman M L. Bioabsorbable stents for gastrointestinal endoscopy. Tech Gastrointest Endosc. 2001; 3 120-125
- 5 Bickston S J, Foley E, Lawrence C et al. Terminal ileal stricture in Crohn’s disease: treatment using a metallic enteral endoprosthesis. Dis Colon Rectum. 2005; 48 1081-1085
- 6 Kita H, Yamamoto H. Double-balloon endoscopy for the diagnosis and treatment of small intestinal disease. Best Pract Res Clin Gastroenterol. 2006; 20 179-194
- 7 Tierney W, Chuttani R, Croffie J et al. Enteral stents. Gastrointest Endosc. 2006; 63 920-926
- 8 Judah J R, Draganov P V. Endoscopic therapy of benign biliary strictures. World J Gastroenterol. 2007; 13 3531-3539
- 9 Bhasin D K, Rana S S. Biodegradable pancreatic stents: are they a disappearing wonder?. Gastrointest Endosc. 2008; 67 1113-1115
- 10 Bures J. Bio-degradable stents. A clever tool to overcome the drawbacks of ”standard treatment“ of refractory stenoses. Folia Gastroenterol Hepatol. 2009; 7 4-6 Available from: http://www.pro-folia.org Accessed: 5 March 2011
- 11 Fry S W, Fleischer D E. Management of a refractory benign esophageal stricture with a new biodegradable stent. Gastrointest Endosc. 1997; 45 179-182
- 12 Goldin E, Fiorini A, Ratan Y et al. A new biodegradable and self-expandable stent for benign esophageal strictures. Gastrointest Endosc. 1996; 43 294
- 13 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
- 14 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
- 15 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
- 16 Bychkova O V, Lazyuk I I, Averin V. Bio-degradable stents – new approach to the treatment of caustic stenoses in children. Folia Gastroenterol Hepatol. 2009; 7 30-34 Available from: http://www.pro-folia.org Accessed: 5 March 2011
- 17 Dhar A, Topping J H, Johns E, O’Neill D. Biodegradable stents in refractory benign oesophageal strictures – first report of 4 patients from UK. Gastrointest Endosc. 2009; 69 AB254-AB255
- 18 Vandenplas Y, Hauser B, Devreker T et al. A biodegradable esophageal stent in the treatment of a corrosive esophageal stenosis in a child. J Pediatr Gastroenterol Nutr. 2009; 49 254-257
- 19 Stivaros S M, Williams L R, Senger C et al. Woven polydioxanone biodegradable stents: a new treatment option for benign and malignant oesophageal strictures. Eur Radiol. 2010; 20 1069-1072
- 20 Repici A, Vleggaar F P, 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
- 21 Parviainen M, Sand J, Harmoinen A et al. A new biodegradable stent for the pancreaticojejunal anastomosis after pancreaticoduodenal resection: in vitro examination and pilot experiences in humans. Pancreas. 2000; 21 14-21
- 22 Petrtyl J, Bruha R, Horak L et al. Management of benign intrahepatic bile duct strictures: initial experience with polydioxanone biodegradable stents. Endoscopy. 2010; 42 (Suppl. 2) E89-E90
- 23 Laukkarinen J, Sand J, Leppiniemi J et al. A novel technique for hepaticojejunostomy for nondilated bile ducts: a purse-string anastomosis with an intra-anastomotic biodegradable biliary stent. Am J Surg. 2010; 200 124-130
- 24 Rejchrt S, Kopacova M, Bartova J, Bures J. Intestinal biodegradable stents. Initial experience in the Czech Republic. Folia Gastroenterol Hepatol. 2009; 7 7-11 Available from: http://www.pro-folia.org Accessed: 5 March 2011
- 25 England R. Case study: Implant of SX-ELLA BD biodegradable stent in patient with post radiotherapy benign oesophageal stricture. BD Clinical Bulletin A44pp.. Sheffield: UK Medical Limited; 2008. Available from: http://www.ukmedical.com/catalogue/stenting/non-vascular-stenting/hv-stent.htm. Accessed 5 March 2011
- 26 Kopacova M, Bures J, Vykouril L et al. Intraoperative enteroscopy: ten years’ experience at a single tertiary center. Surg Endosc. 2007; 21 1111-1116
- 27 Kopacova M, Rejchrt S, Tacheci I, Bures J. Hyperamylasemia of uncertain significance associated with oral double-balloon enteroscopy. Gastrointest Endosc. 2007; 66 1133-1138
- 28 Rejchrt S, Kopacova M, Tacheci I, Bures J. Interventional double balloon endoscopy for Crohn’s, gastrointestinal bleeding, and foreign body extraction. Tech Gastrointest Endosc. 2008; 10 101-106
- 29 Freudenberg S, Rewerk S, Kaess M et al. Biodegradation of absorbable sutures in body fluids and pH buffers. Eur Surg Res. 2004; 36 376-385
- 30 Gunatillake P, Mayadunne R, Adhikari R. Recent developments in biodegradable synthetic polymers. Biotechnol Annu Rev. 2006; 12 301-347
- 31 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
- 32 Hair C S, Devonshire D A. 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
S. RejchrtMD, PhD
2nd Department of Internal Medicine
University Teaching Hospital
Sokolska 581
50005 Hradec Kralove
Czech Republic
Fax: +420-495-834785
Email: rejchrt@lfhk.cuni.cz