A 56-year-old woman with a total gastrectomy and an esophagojejunal
anastomosis developed a severe stricture of the surgical anastomosis ([Fig. 1 ]).
Fig. 1 Severe stricture of the
surgical anastomosis.
The stricture was radiologically dilated, resulting in perforation
during the dilation maneuvers. The perforation was resolved nonsurgically. The
stricture recurred, so we placed a covered metal stent that was removed after
2
months, but the stricture recurred again afterwards.
In this situation, we decided to place the SX-Ella-BD (Ella-CS,
s. r. o., Hradec Králové, Czech Republic) – a
new polydioxanone (PDS) biodegradable stent – under radiologic and
endoscopic guidance ([Fig. 2 ]).
Fig. 2 Stent placement.
Three months later the patient attended complaining of progressive
dysphagia. Endoscopy revealed that the stent had already degraded, and a new
severe stricture caused by hyperplastic inflammatory tissue was found at the
level corresponding to the position of the proximal end of the stent ([Fig. 3
and 4 ]).
Fig. 3 Inflammatory tissue
developing.
Fig. 4 New stricture caused by
inflammatory tissue hyperplasia that developed within the proximal end of the
stent 14 weeks after the stent was placed.
The first (postsurgical) stricture now had a slightly larger
diameter than before the stent placement. The hyperplasia was successfully
dilated endoscopically ([Fig. 5 ]).
Fig. 5 Dilation of the
stenosis.
The dysphagia disappeared after dilation of the hyperplastic
stricture.
It is assumed that the biocompatibility characteristics of the new
biodegradable stents may avoid the risk of developing new hyperplastic
strictures better than the commonly used self-expanding plastic (SEPS) and
metal stents (SEMS) [1 ]
[2 ]
[3 ]
[4 ]
[5 ]. We report the development in our patient of severe
epithelial hyperplasia as a complication of a novel biodegradable stent. This
new stricture was treated effectively with balloon dilation. To our knowledge,
this is the first case in which this complication has been reported in
association with this kind of biodegradable stent.
Despite the effectiveness of biodegradable stents in dilating
strictures, and even despite their being theoretically biocompatible, they may
not be able to confer exemption from the development of hyperplastic
strictures. The hyperplasia was easily and successfully dilated. Further
studies are needed to determine the real effectivity and safety of this
stent.
Endoscopy_UCTN_Code_CPL_1AJ_2AF