Expanding Role of Self Expanding Esophageal Stents

Kulwinder S Dua

doi:10.1055/s-0039-1700253

Journal of Digestive Endoscopy, Table of Contents

CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2011; 02(01): 009-014
DOI: 10.1055/s-0039-1700253

Review Article

Society of Gastrointestinal Endoscopy of India

Expanding Role of Self Expanding Esophageal Stents

Authors

Kulwinder S Dua

Director, Advanced GI Endoscopy Fellowship, Medical College of Wisconsin, Milwaukee, USA

Abstract

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ABSTRACT

Esophageal cancer is often diagnosed at a late stage and hence carries a poor prognosis with an overall 5-year survival rate of 10% to 15%. Therefore, palliative treatment primarily aimed at the relieving dysphagia is the only available option. Endoscopic placement of self expanding metal stents (SEMS) has become a widely used method for palliation offering prompt relief of dysphagia and numerous reports have shown it to be safe and effective. Secondary to tissue in-growth into the uncovered segments of the stent, SEMS cannot be removed and hence are not approved for benign indications. With the advent of the removable self expanding plastic stents, the indications for esophageal stent insertion have expanded to as bridge to surgery for patients undergoing neoadjuvant chemotherapy, for refractory benign esophageal strictures, for non- malignant esophageal perforations, leaks and fistulae, and even for variceal hemorrhage. Newer fully covered SEMS that are potentially removable are also being tried for benign indications but await FDA clearance. Similarly biodegradeable stents for benign disorders and radioactive or drug-eluding stents for malignant disease are hoped to improve the management of esophageal diseases. The purpose of this article is to review the expanding role of self expanding stents in the management of esophageal disorders other than palliating malignant dysphagia and fistulae.(J Dig Endos 2011;2(1):9-14)

Keywords:

Esophageal cancer - Malignant dysphagia - Refractory benign esophageal stricture - Esophageal perforation leaks - Fistulae - Self expanding metal stent - Self expanding polyflex stent - Biodegradeable esophageal stent

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References

References
1 Domschke W, Foerster EC, Matek W, Rodl W. Self-expanding mesh stent for esophageal cancer stenosis. Endoscopy 1990;22:134-6.
2 Knyrim K, Wagner HJ, Bethge N, Keymling M, Vakil N. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med 1993;329:1302–7.
3 Eickhoff A, Knoll M, Jakobs R, Weickert U, Hartmann D, Schilling D, Eickhoff JC. Self-expanding metal stents versus plastic prostheses in the palliation of malignant dysphagia: long-term outcome of 153 consecutive patients. J Clin Gastroenterol 2005;39:877-85.
4 Roseveare CD, Patel P, Simmonds N, Goggin PM, Kimble J, Shepherd HA et al. Metal stents improve dysphagia, nutrition and survival in malignant oesophageal stenosis: a randomized controlled trial comparing modified Gianturco Z-stents with plastic Atkinson tubes. Eur J Gastroenterol Hepatol 1998; 10:653-7.
5 Siersema PD, Hop WC, van Blankenstein M, van Tilburg AJ, Bac DJ, Homs MY, Kuipers EJ. A comparison of 3 typesof covered metal stents for the palliation of patients with Dysphagia caused by esophagogastric carcinoma: a prospective, randomized study. Gastrointest Endosc 2001;54:145-53.
6 Kinsman KJ, DeGregorio BT, Katon RM, Morrison K, Saxon RR, Keller FS, Rosch J. Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy. Gastrointest Endosc 1996;43:196-203.
7 Lecleire S, Di Fiore F, Ben-Soussan E, Antonietti M, Hellot MF, Paillot B, Lerebours E. Prior chemoradiotherapy is associated with a higher life-threatening complication rate after palliative insertion of metal stents in patients with oesophageal cancer. Aliment Pharmacol Ther 2006;23:1693-702.
8 Adler DG, Fang J, Wong R, Wills J, Hilden K.. Placement of Polyflex stents in patients with locally advanced esophageal cancer is safe and improves dysphagia during neoadjuvant therapy. Gastrointest Endosc 2009;70:614-9.
9 Martin R, Duvall R, Ellis S, Scoggins CR. The use of self-expanding silicone stents in esophageal cancer care: optimal pre-, peri-, and postoperative care. Surg Endosc 2009;23:615-21.
10 Siddiqui AA, Loren D, Dudnick R, Kowalski T. Expandable polyester siliconcovered stent for malignant esophageal structures before neoadjuvant chemoradiation: a pilot study. Dig Dis Sci 2007;52:823-9.
11 Ross WA, Alkassab F, Lynch PM, Ayers GD, Ajani J, Lee JH, Bismar M. Evolving role of self-expanding metal stents in the treatment of malignant dysphagia and fistulae. Gastrointest Endosc 2007;65:70-6.
12 Yakami M, Mitsumori M, Sai H, Nagata Y, Hiraoka M, Nishimura Y. Development of severe complications caused by stent placement followed by definitive radiation therapy for T4 esophageal cancer. Int J Clin Oncol 2003;8:395-8.
13 Shin JH, Song HY, Kim JH, Kim SB, Lee GH, Park SI, Han YM, Comparison of temporary and permanent stent placement with concurrent radiation therapy in patients with esophageal carcinoma. J Vasc Interv Radiol 2005;16:67-74.
14 Spechler SJ. American Gastroenterology Association medical position statement on treatment of patients with dysphagia caused by benign disorders of the distal esophagus. Gastroenterology 1999;117:229-32.
15 Said A, Brust DJ, Gaumnitz EA, Reichelderfer M. Predictors of early recurrence of benign esophageal strictures. Am J Gastroenterol 2003;98:1252-6.
16 Siersemma PD, Wsijkerslooth LR. Dilation of refractory benign esophageal strictures. Gastrointest Endosc 2009; 70:1000-12.
17 Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc 2005;62:474-75.
18 Sandha GS, Marcon NE. Expandable metal stents for benign esophageal obstruction. Gastrointest Endosc Clin N Am 1999; 9:437-46.
19 Wadhwa RP, Kozarek RA, France RE, Brandabur JJ, Gluck M, Low DE, Traverso LW. Use of self-expandable metallic stents in benign GI diseases. Gastrointest Endosc 2003;58:207-12.
20 Fiorini A, Fleischer D, Valero J, Israeli E, Wengrower D, Goldin E. Self-expandable metal coil stents in the treatment of benign esophageal strictures refractory to conventional therapy: a case series. Gastrointest Endosc 2000;52:259-62.
21 Song HY, Park SI, Do YS, Yoon HK, Sung KB, Sohn KH. Expandable metallic stent placement in patients with benign esophageal strictures: results of long-term follow-up. Radiology 1997;203:131-6.
22 Ackroyd R, Watson DI, Devitt PG, Jamieson GG. Expandable metallic stents should not be used in the treatment of benign esophageal strictures. J Gastroenterol Hepatol 2001;16:484-7.
23 Repici A, Conio M, De Angelis C, Battaglia E, Musso A, Pellicano R, Goss M. Temporary placement of an expandable polyester silicone-covered stent for treatment of refractory benign esophageal strictures. Gastrointest Endosc 2004;60:513-9.
24 Pungpapong S, Raimondo M, Wallace M. Problematic esophageal stricture: an emerging indication for self-expandable silicone stents. Gastrointest Endosc 2004;60:842-45.
25 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.
26 Triester SL, Fleisher DE, Sharma VK. Failure of self-expanding plastic stents in treatment of refractory benign esophageal strictures. Endoscopy 2006;38:533-7.
27 Holm AN, Levy JL, Gostout CJ, Topazian M, Baron T. Self-expanding plastic stents in treatment of benign esophageal conditions. Gastrointest Endosc 2008;67:20-5.
28 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;103:2988-94.
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; 55:1344-8.
30 Baron TH, Burgart LJ, Pochron NL. An internally covered (lined) selfexpanding metal esophageal stent: tissue response in a porcine model. Gastrointest Endosc 2006;64:263-7.
31 Lakhtakia S, Reddy ND, Dua KS. Refractory benign esophageal strictures: continuous, non-permanent dilation with a self-expandable metal esophageal stent (Alimaxx-E). Gastrointest Endosc 2007;65:AB284.
32 Eloubeidi MA, Lopes TL. Novel removable internally fully covered self-expanding metal esophageal stent: Feasibilty, technique of removal and tissue response in humans. Am J Gastroenterol 104:1374-81.
33 Song HY, Park SI, Jung HY, Kim SB, Kim JH, Huh SJ, Kim TH. Benign and malignant esophageal sterictures: treatment with a polyurethane-covered retrievable expandable metallic stent. Radiology 1997;203:747-52.
34 Song HY, Jung HY, Park SI, Kim SB, Lee DH, Kang SG, Il Min Y. Covered retrievable expandable nitinol stents in patients with benign esophageal strictures:initial experience. Radiology 2000;217:551-7.
35 Saito Y, Tanaka T, Andoh A, Minematsu H, Hata K, Tsujikawa T, Nitta N,. Usefulness of biodegradable stents constructed of poly-l-lactic acid monofilaments in patients with benign esophageal stenosis. World J Gastroenterol 2007;13:3977-80.
36 Siersema PD, Homs MY, Haringsma J, Tilanus HW, Kuipers EJ. Use of large-diameter metallic stents to seal traumatic nonmalignant perforations of the esophagus. Gastrointest Endosc 2003;58:356-61.
37 Johnsson E, Lundell L, Liedman B. Sealing of esophageal perforation or ruptures with expandable metallic stents: a prospective controlled study on treatment efficacy and limitations. Dis Esophagus 2005;18:262-6.
38 Freeman RK, Van Woerkom JM, Ascioti AJ. Esophageal stent placement for the treatment of iatrogenic intrathoracic esophageal perforation. Ann Thorac Surg 2007;83:2003-7.
39 Chung MG, Kang DH, Park DK, Park JJ, Park HC, Kim JH. Successful treatment of Boerhaave’s syndrome with endoscopic insertion of a self-expandable metallic stent: report of three cases and a review of the literature. Endoscopy 2001;33:894-7.
40 Petruzziello L, Tringali A, Riccioni ME, Mutignani M, Margaritora S, Cesario A, Costamagna G. Successful early treatment of Boerhaave’s syndrome by endoscopic placement of a temporary self-expandable plastic stent without fluoroscopy. Gastrointest Endosc 2003;58:608-12.
41 van Heel NCM, Haringsma J, Spaander MCW, Bruno MJ, Kuipers EJ. Short-term esophageal stenting in the management of benign perforations. Am J Gastroenterol 2010; 105:1515–20.
42 Schubert D, Scheidbach H, Kuhn R, Wex C, Weiss G, Eder F, Lippert H. Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 2005;61:891-6.
43 Langer FB, Wenzl E, Prager G, Salat A, Miholic J, Mang T, Zacherl J. Management of postoperative esophageal leaks with the Polyflex self-expanding covered plastic stent. Ann Thorac Surg 2005;79:398-403.
44 Eleft heriadis E, Kotzampassi K. Temporary stenting of acquired benign tracheoesophageal fistulas in critically ill ventilated patients. Surg Endosc 2005;19:811-5.
45 G Wright, H Lewis, B Hogan, Burroughs A, Patch D, O’Beirne J. A self-expanding metal stent for complicated variceal hemorrhage: experience at a single center. Gastrointest Endosc 2010;71:71-78.