Prophylactic stenting as a method to decrease incidence of post ESD strictures in esophagus. A case series

Aims Endoscopic submucosal dissection (ESD) allows curative en bloc resection of large early esophageal neoplasms with low recurrence rates. However, these large resections almost invariably lead to recalcitrant esophageal strictures. Prophylactic use of fully covered metal stents to prevent such strictures has been seldomly used. In this case series we evaluated the effectiveness of such an approach.

Methods Data on patients who underwent extensive ESD (>50 % circumference) for a variety of lesions was collected retrospectively. Only patients in whom stent was placed within 24 hrs of the resection, no other stricture preventing measures were used and with follow up endoscopy after ≥3 months of resection were included. Post ESD stricture was defined as a clinically significant one requiring any kind of treatment [1].

Results A total of 8 patients were analyzed. The mean age was 69 years, and 4 were males. All patients except one underwent circumferential resections (mean length 6 cm). Stents were placed immediately after resection except in one case and all of them were anchored using different methods. The mean interval from placement to removal was 35 days. Stricture was avoided in 5 patients (63%). Stent migration ocurred in 2 patients and no serious adverse events were noted. In one case the stent had to be removed 4 days after placement due to severe discomfort ([Table 1]).

Table 1

Conclusions Prophylactic use of fully covered metal stents after extensive ESD seems to be an effective approach at preventing clinically significant strictures. This method should be studied in prospective trials to further assess its effectiveness.

Publication History

Article published online:
14 April 2023

• 1 Bhatt A, Abe S, Kumaravel A. et al. Indications and Techniques for Endoscopic Submucosal Dissection. Am J Gastroenterol 2015; 110 (06) 784-91