Skip to main content
SpringerLink
Log in
Book cover

Self-Expandable Stents in the Gastrointestinal Tract pp 73–87Cite as

Esophageal Prostheses

  • Chapter
  • First Online:

Abstract

This chapter describes the esophageal stents currently used for malignant and benign conditions. Self-expandable metal stents (SEMS) have become the most used endoprostheses for palliation of malignant dysphagia due to esophageal-esophagogastric junction cancer and mediastinal malignancy. Stents have also been proved effective in the management of esophagorespiratory fistula (ERF), anastomotic leaks, and ruptures. They allow early resumption of an almost normal diet. However, SEMS are associated with early and late complications that in some instances may be fatal. The Food and Drug Administration (FDA) has approved a self-expanding plastic stent (SEPS), because of its easy removal, for benign disease. The role of SEMS in benign strictures is challenging and sometimes risky, but experience in this field, although encouraging, is limited. Currently, several types of SEMS, including a reabsorbable type, are marketed, but no randomized studies comparing them are available. Migration, benign or malignant overgrowth, and easy removal remain unsolved problems.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Schembre DB. Recent advances in the use of stents for esophageal disease. Gastrointest Endosc Clin N Am. 2010;20:103–21.

    Article  PubMed  Google Scholar 

  2. Mohan V, Kozarek RA. Placement of conventional and expandable stents for malignant esophageal stenoses. Tech Gastrointest Endosc. 2001;3: 166–75.

    Article  Google Scholar 

  3. Xinopoulos D, Dimitroulopoulos D, Moschandrea I, et al. Natural course of inoperable esophageal cancer treated with metallic expandable stents: quality of life and cost-effectiveness analysis. J Gastroenterol Hepatol. 2004;19:1397–402.

    Article  PubMed  Google Scholar 

  4. Madhusudhan C, Saluja SS, Pal S, Ahuja V, et al. Palliative stenting for relief of dysphagia in patients with inoperable esophageal cancer: impact on quality of life. Dis Esophagus. 2009;22:331–6.

    Article  PubMed  Google Scholar 

  5. Maroju NK, Anbalagan P, Kate V, et al. Improvement in dysphagia and quality of life with self-expanding metallic stents in malignant esophageal strictures. Indian J Gastroenterol. 2006;25:62–5.

    PubMed  Google Scholar 

  6. White RE, Parker RK, Fitzwater JW, et al. Stents as sole therapy for oesophageal cancer: a prospective analysis of outcomes after placement. Lancet Oncol. 2009;10:240–6.

    Article  PubMed  Google Scholar 

  7. Langer FB, Zacherl J. Palliative endoscopic interventions in esophageal cancer. Eur Surg. 2007;39: 288–94.

    Article  Google Scholar 

  8. Siersema PD. New developments in palliative therapy. Best Pract Res Clin Gastroenterol. 2006;20:959–78.

    Article  PubMed  Google Scholar 

  9. Hayter CR, Huff-Winters C, Paszat L, et al. A prospective trial of short-course radiotherapy plus chemotherapy for palliation of dysphagia from advanced esophageal cancer. Radiother Oncol. 2000;56: 329–33.

    Article  PubMed  CAS  Google Scholar 

  10. Homs MY, Steyerberg EW, Eijkenboom WM, et al. Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet. 2004;364:1497–504.

    Article  PubMed  Google Scholar 

  11. Bower M, Jones W, Vessels B, et al. Nutritional support with endoluminal stenting during neoadjuvant therapy for esophageal malignancy. Ann Surg Oncol. 2009;16:3161–8.

    Article  PubMed  Google Scholar 

  12. Spechler SJ. American Gastroenterological Association medical position statement on treatment of patients with dysphagia caused by benign disorders of the distal esophagus. Gastroenterology. 1999;117:229–33.

    Article  PubMed  CAS  Google Scholar 

  13. Ferguson DD. Evaluation and management of benign esophageal strictures. Dis Esophagus. 2005;18:359–64.

    Article  PubMed  CAS  Google Scholar 

  14. Lew RJ, Kochman ML. A review of endoscopic methods of esophageal dilation. J Clin Gastroenterol. 2002;35:117–26.

    Article  PubMed  Google Scholar 

  15. Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc. 2005;62:474–5.

    Article  PubMed  Google Scholar 

  16. Thomas T, Abrams KR, Subramanian V, et al. Esophageal stents for benign refractory strictures: a meta-analysis. Endoscopy. 2011;43:386–93.

    Article  PubMed  CAS  Google Scholar 

  17. Repici A, Hassan C, Sharma P, et al. Systematic review: the role of self-expanding plastic stents for benign oesophageal strictures. Aliment Pharmacol Ther. 2010;31:1268–75.

    Article  PubMed  CAS  Google Scholar 

  18. Conio M, Blanchi S, Filiberti R, et al. A modified self-expanding Niti-S stent for the management of benign hypopharyngeal strictures. Gastrointest Endosc. 2007;65:714–20.

    Article  PubMed  Google Scholar 

  19. Repici A, Vleggaar FP, 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: 927–34.

    Article  PubMed  Google Scholar 

  20. Repici A, Conio M, De Angelis C, et al. Temporary placement of an expandable polyester silicone-covered stent for treatment of refractory benign esophageal strictures. Gastrointest Endosc. 2004;60:513–9.

    Article  PubMed  Google Scholar 

  21. Eloubeidi MA, Talreja JP, Lopes TL, et al. Success and complications associated with placement of fully covered removable self-expandable metal stents for benign esophageal diseases (with videos). Gastrointest Endosc. 2011;73:673–81.

    Article  PubMed  Google Scholar 

  22. Baron TH. Role of endoscopy in the management of esophageal diseases. Minerva Gastroenterol Dietol. 2008;54:415–27.

    PubMed  CAS  Google Scholar 

  23. Schembre D. Advances in esophageal stenting: the evolution of fully covered stents for malignant and benign disease. Adv Ther. 2010;27:413–25.

    Article  PubMed  Google Scholar 

  24. Ross WA, Alkassab F, Lynch PM, et al. Evolving role of self-expanding metal stents in the treatment of malignant dysphagia and fistulas. Gastrointest Endosc. 2007;65:70–7.

    Article  PubMed  Google Scholar 

  25. Dai Y, Chopra SS, Kneif S, Hünerbein M. Management of esophageal anastomotic leaks, perforations, and fistulae with self-expanding plastic stents. J Thorac Cardiovasc Surg. 2011;141:1213–7.

    Article  PubMed  Google Scholar 

  26. Sharma P, Kozarek R. Role of esophageal stents in benign and malignant diseases. Practice parameters committee of American College of gastroenterology. Am J Gastroenterol. 2010;105:258–73.

    Article  PubMed  Google Scholar 

  27. Ramirez FC, Dennert B, Zierer ST, Sanowski RA. Esophageal self-expandable metallic stents–indications, practice, techniques, and complications: results of a national survey. Gastrointest Endosc. 1997;45: 360–4.

    Article  PubMed  CAS  Google Scholar 

  28. O’Donnell CA, Fullarton GM, Watt E, et al. Randomized clinical trial comparing self-expanding metallic stents with plastic endoprostheses in the palliation of oesophageal cancer. Br J Surg. 2002;89: 985–92.

    Article  PubMed  Google Scholar 

  29. Siersema PD, Hop WC, Dees J, et al. Coated self-expanding metal stents versus latex prostheses for esophagogastric cancer with special reference to prior radiation and chemotherapy a controlled, prospective study. Gastrointest Endosc. 1998;47:113–20.

    Article  PubMed  CAS  Google Scholar 

  30. Yakoub D, Fahmy R, Athanasiou T, et al. Evidence-based choice of esophageal stent for the palliative management of malignant dysphagia. World J Surg. 2008;32:1996–2009.

    Article  PubMed  Google Scholar 

  31. Conio M, Blanchi S, Filiberti R, De Ceglie A. Self-expanding plastic stent to palliate symptomatic tissue in/overgrowth after self-expanding metal stent placement for esophageal cancer. Dis Esophagus. 2010;23:590–6.

    Article  PubMed  CAS  Google Scholar 

  32. Vakil N, Morris AI, Marcon N, et al. A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction. Am J Gastroenterol. 2001;96:1791–6.

    Article  PubMed  CAS  Google Scholar 

  33. Saranovic DJ, Djuric-Stefanovic A, Ivanovic A, et al. Fluoroscopically guided insertion of self-expandable metal esophageal stents for palliative treatment of patients with malignant stenosis of esophagus and cardia: comparison of uncovered and covered stent types. Dis Esophagus. 2005;18:230–8.

    Article  PubMed  Google Scholar 

  34. Baron TH. A practical guide for choosing an expandable metal stent for GI malignancies: is a stent by any other name still a stent? Gastrointest Endosc. 2001;54:269–72.

    Article  PubMed  CAS  Google Scholar 

  35. Conio M, Repici A, Battaglia G, et al. A randomized prospective comparison of self-expandable plastic stents and partially covered self-expandable metal stents in the palliation of malignant esophageal dysphagia. Am J Gastroenterol. 2007;102:2667–77.

    Article  PubMed  Google Scholar 

  36. Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med. 2001;344:1681–7.

    Article  PubMed  CAS  Google Scholar 

  37. Nicholson DA, Haycox A, Kay CL, et al. The cost effectiveness of metal oesophageal stenting in malignant disease compared with conventional therapy. Clin Radiol. 1999;54:212–5.

    Article  PubMed  CAS  Google Scholar 

  38. Rao C, Haycock A, Zacharakis E, et al. Economic analysis of esophageal stenting for management of malignant dysphagia. Dis Esophagus. 2009;22:337–47.

    Article  PubMed  CAS  Google Scholar 

  39. Conio M, De Ceglie A, Blanchi S, Fisher DA. Esophageal strictures, tumors, and fistulae: stents for primary esophageal cancer. Tech Gastrointest Endosc. 2010;12:191–202.

    Article  Google Scholar 

  40. Sabharwal T, Hamady MS, Chui S, et al. A randomised prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma. Gut. 2003;52:922–6.

    Article  PubMed  CAS  Google Scholar 

  41. Karbowski M, Schembre D, Kozarek R, et al. Polyflex self-expanding, removable plastic stents: assessment of treatment efficacy and safety in a variety of benign and malignant conditions of the esophagus. Surg Endosc. 2008;22:1326–33.

    Article  PubMed  CAS  Google Scholar 

  42. Siersema PD, Dees J, van Blankenstein M. Palliation of malignant dysphagia from oesophageal cancer. Rotterdam oesophageal tumor study group. Scand J Gastroenterol. 1998;225(Suppl):75–84.

    CAS  Google Scholar 

  43. Costamagna G, Shah SK, Tringali A, et al. Prospective evaluation of a new self-expanding plastic stent for inoperable esophageal strictures. Surg Endosc. 2003;17: 891–5.

    Article  PubMed  CAS  Google Scholar 

  44. Siersema PD, Hop WC, van Blankenstein M, et al. A comparison of 3 types of covered metal stents for the palliation of patients with dysphagia caused by esophagogastric carcinoma: a prospective, randomized study. Gastrointest Endosc. 2001;54:145–53.

    Article  PubMed  CAS  Google Scholar 

  45. Verschuur EM, Repici A, Kuipers EJ, et al. New design esophageal stents for the palliation of dysphagia from esophageal or gastric cardia cancer: a randomized trial. Am J Gastroenterol. 2008;103:304–12.

    Article  PubMed  Google Scholar 

  46. Verschuur EM, Steyerberg EW, Kuipers EJ, Siersema PD. Effect of stent size on complications and recurrent dysphagia in patients with esophageal or gastric cardia cancer. Gastrointest Endosc. 2007;65:592–601.

    Article  PubMed  Google Scholar 

  47. Homs MY, Steyerberg EW, Kuipers EJ, et al. Causes and treatment of recurrent dysphagia after self-expanding metal stent placement for palliation of esophageal carcinoma. Endoscopy. 2004;36:880–6.

    Article  PubMed  CAS  Google Scholar 

  48. Dua KS, Kozarek R, Kim J, et al. Self-expanding metal esophageal stent with anti-reflux mechanism. Gastrointest Endosc. 2001;53:603–13.

    Article  PubMed  CAS  Google Scholar 

  49. Do YS, Choo SW, Suh SW, et al. Malignant esophagogastric junction obstruction: palliative treatment with an antireflux valve stent. J Vasc Interv Radiol. 2001;12:647–51.

    Article  PubMed  CAS  Google Scholar 

  50. Homs MY, Wahab PJ, Kuipers EJ, Steyerberg EW, et al. Esophageal stents with antireflux valve for tumors of the distal esophagus and gastric cardia: a randomized trial. Gastrointest Endosc. 2004;60: 695–702.

    Article  PubMed  Google Scholar 

  51. Sabharwal T, Gulati MS, Fotiadis N, et al. Randomised comparison of the FerX Ella antireflux stent and the Ultraflex stent: proton pump inhibitor combination for prevention of post-stent reflux in patients with esophageal carcinoma involving the esophago-gastric junction. J Gastroenterol Hepatol. 2008;23:723–8.

    Article  PubMed  Google Scholar 

  52. Blomberg J, Wenger U, Lagergren J, et al. Antireflux stent versus conventional stent in the palliation of distal esophageal cancer. A randomized, multicenter clinical trial. Scand J Gastroenterol. 2010;45:208–16.

    Article  PubMed  Google Scholar 

  53. Laasch HU, Marriott A, Wilbraham L, et al. Effectiveness of open versus antireflux stents for palliation of distal esophageal carcinoma and prevention of symptomatic gastroesophageal reflux. Radiology. 2002;225:359–65.

    Article  PubMed  Google Scholar 

  54. Shim CS, Jung IS, Cheon YK, et al. Management of malignant stricture of the esophagogastric junction with a newly designed self-expanding metal stent with an antireflux mechanism. Endoscopy. 2005;37: 335–9.

    Article  PubMed  CAS  Google Scholar 

  55. Sgourakis G, Gockel I, Radtke A, et al. The use of self-expanding stents in esophageal and gastroesophageal junction cancer palliation: a meta-analysis and meta-regression analysis of outcomes. Dig Dis Sci. 2010;55:3018–30.

    Article  PubMed  Google Scholar 

  56. Adler DG, Fang J, Wong R, et al. 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.

    Article  PubMed  Google Scholar 

  57. Siddiqui AA, Glynn C, Loren D, et al. Self-expanding plastic esophageal stents versus jejunostomy tubes for the maintenance of nutrition during neoadjuvant chemoradiation therapy in patients with esophageal cancer: a retrospective study. Dis Esophagus. 2009;22: 216–22.

    Article  PubMed  CAS  Google Scholar 

  58. Langer FB, Schoppmann SF, Prager G, et al. Temporary placement of self-expanding oesophageal stents as bridging for neo-adjuvant therapy. Ann Surg Oncol. 2010;17:470–5.

    Article  PubMed  Google Scholar 

  59. Lopes TL, Eloubeidi MA. A pilot study of fully covered self-expandable metal stents prior to neoadjuvant therapy for locally advanced esophageal cancer. Dis Esophagus. 2010;23:309–15.

    Article  PubMed  CAS  Google Scholar 

  60. Vleggaar FP. Stent placement in esophageal cancer as a bridge to surgery. Gastrointest Endosc. 2009;70:620–2.

    Article  PubMed  Google Scholar 

  61. Uitdehaag MJ, van Hooft JE. A fully-covered stent (Alimaxx-E) for the palliation of malignant dysphagia: a prospective follow-up study. Gastrointest Endosc. 2009;6:1082–9.

    Article  Google Scholar 

  62. Bakken JC, Wong Kee Song LM, de Groen PC, Baron TH. Use of a fully covered self-expandable metal stent for the treatment of benign esophageal diseases. Gastrointest Endosc. 2010;72:712–20.

    Article  PubMed  Google Scholar 

  63. Irani S, Kozarek R. Esophageal stents: past, present, and future. Tech Gastrointest Endosc. 2010;12:178–90.

    Article  Google Scholar 

  64. Kim ES, Jeon SW, Park SY, et al. Comparison of double-layered and covered Niti-S stents for palliation of malignant dysphagia. J Gastroenterol Hepatol. 2009;24:114–9.

    Article  PubMed  Google Scholar 

  65. Kim JH, Song HY, Choi EK, et al. Temporary metallic stent placement in the treatment of refractory benign esophageal strictures: results and factors associated with outcome in 55 patients. Eur Radiol. 2009;19:384–90.

    Article  PubMed  Google Scholar 

  66. Uitdehaag MJ, Siersema PD, Spaander MC, et al. A new fully covered stent with antimigration properties for the palliation of malignant dysphagia: a prospective cohort study. Gastrointest Endosc. 2010;71:600–5.

    Article  PubMed  Google Scholar 

  67. Mishin I, Ghidirim G, Dolghii A, et al. Implantation of self-expanding metal stent in the treatment of severe bleeding from esophageal ulcer after endoscopic band ligation. Dis Esophagus. 2010;23: E35–8.

    Article  PubMed  CAS  Google Scholar 

  68. Wright G, Lewis H, Hogan B, et al. A self-expanding metal stent for complicated variceal hemorrhage: experience at a single center. Gastrointest Endosc. 2010;71:71–8.

    Article  PubMed  Google Scholar 

  69. Zehetner J, Shamiyeh A, Wayand W, Hubmann R. Results of a new method to stop acute bleeding from esophageal varices: implantation of a self-expanding stent. Surg Endosc. 2008;22:2149–52.

    Article  PubMed  CAS  Google Scholar 

  70. 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;13:3977–80.

    PubMed  Google Scholar 

  71. 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.

    Article  PubMed  CAS  Google Scholar 

  72. Hair CS, Devonshire DA. Severe hyperplastic tissue stenosis of a novel biodegradable esophageal stent and subsequent successful management with high-pressure balloon dilation. Endoscopy. 2010;42(Suppl 2):E132–3.

    Article  PubMed  Google Scholar 

  73. van Boeckel PG, Vleggaar FP, Siersema PD. A comparison of temporary self-expanding plastic and biodegradable stents for refractory benign esophageal strictures. Clin Gastroenterol Hepatol. 2011;9: 653–9.

    Article  PubMed  Google Scholar 

  74. Jeon SR, Eun SH, Shim CS, et al. Effect of drug-eluting metal stents in benign esophageal stricture: an in vivo animal study. Endoscopy. 2009;41: 449–56.

    Article  PubMed  CAS  Google Scholar 

  75. Guo SR, Wang ZM, Zhang YQ, et al. In vivo evaluation of 5-fluorouracil-containing self-expandable nitinol stent in rabbits: efficiency in long-term local drug delivery. J Pharmacol Sci. 2010;99: 3009–18.

    CAS  Google Scholar 

Further Reading

  1. Power C, Byrne K, Lim K, et al. Superiority of anti-reflux stent compared with conventional stents in the palliative management of patients with cancer of the lower esophagus and esophago-gastric junction: results of a randomized clinical trial. Dis Esophagus. 2007;20:466–70.

    Article  PubMed  CAS  Google Scholar 

  2. Wenger U, Johnsson E, Arnelo U, et al. An antireflux stent versus conventional stents for palliation of distal esophageal or cardia cancer: a randomized clinical study. Surg Endosc. 2006;20: 1675–80.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Digestive Endoscopy, General Hospital Sanremo, C.so Garibaldi 187, 3, Sanremo, IM, 18038, Italy

    Massimo Conio M.D.

  2. Department of Gastroenterology and Digestive Endoscopy, Cancer Institute Giovanni Paolo II, Bari, Italy

    Antonella De Ceglie M.D.

Authors
  1. Massimo Conio M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonella De Ceglie M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Massimo Conio M.D. .

Editor information

Editors and Affiliations

  1. , Virginia Mason Medical Center, Digestive Disease Institute, 1100 Ninth Ave, Seattle, 98111, Washington, USA

    Richard Kozarek

  2. , Division of Gastroenterology and Hepatol, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, 55905, Minnesota, USA

    Todd Baron

  3. , Department of Radiology, Asan Medical Center, Pungnap-2Dong 388-1, Seoul, 138-736, Korea, Republic of (South Korea)

    Ho-Young Song

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Conio, M., De Ceglie, A. (2013). Esophageal Prostheses. In: Kozarek, R., Baron, T., Song, HY. (eds) Self-Expandable Stents in the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3746-8_5

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-3746-8_5

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-3745-1

  • Online ISBN: 978-1-4614-3746-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation