Skip to main content

Advertisement

SpringerLink
Log in

A new designed self-expandable metal stent for the management of benign radiotherapy-induced hypopharyngeal or cervical esophageal strictures

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background and aims

The management of patients with hypopharyngeal or cervical esophageal refractory benign strictures (RBS) after surgery and radiotherapy ± chemotherapy for laryngeal cancer is challenging. We aimed to assess the long-term efficacy and safety of a new designed fully covered SEMS in these patients.

Methods

We reviewed the results of a prospectively collected database of 40 consecutive patients with dysphagia due to RBS of the cervical esophagus or hypopharynx after surgery and radiotherapy with or without chemotherapy for laryngeal cancer, unfit for surgery, referred in two tertiary-care endoscopic centers from June 2005 to December 2018. All of them were treated with placement of a Niti-S Conio cervical stent.

Results

After placement of the first stent, dysphagia improved in all patients. The total number of adverse events was 35 out of a total of 299 procedures (11.7%): 25 (8.4%) stent migrations, 6 (2%) tumor overgrowth, 3 severe pain and 1 pharyngo-cutaneous fistula. Stents were periodically changed. In only one patient with a cervical esophageal stricture the stent was definitively removed after 7 sessions of stent placement because of stricture resolution. Patients were followed-up for a median of 11.6 months and a significant improvement in dysphagia was reported in all patients (p < 0.001).

Conclusions

The use of this conformable, small caliber new designed Niti-S stent, exchanged periodically, appeared safe and permitted durable oral intake in patients with difficult-to-treat hypopharyngeal or cervical esophagus strictures, avoiding the need for periodic dilations.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jalisi M, Jalisi S (2005) Advanced laryngeal carcinoma: surgical and non-surgical management options. OtolaryngolClin North Am 38:47–57

    Article  CAS  Google Scholar 

  2. Laurell G, Kraepelien T, Mavroidis P, Lind BK, Fernberg JO, Beckman M, Lind MG (2003) Stricture of the proximal esophagus in head and neck carcinoma patients after radiotherapy. Cancer 97:1693–1700

    Article  Google Scholar 

  3. Tang SJ, Singh S, Truelson JM (2010) Endotherapy for severe and complete pharyngo-esophageal post-radiation stenosis using wires, balloons and pharyngo-esophageal puncture (PEP) (with videos). SurgEndosc 24:210–214

    Google Scholar 

  4. Repici A, Conio M, De Angelis C, Battaglia E, Musso A, Pellicano R, Goss M, Venezia G, Rizzetto M, Saracco G (2004) Temporary placement of an expandable polyester silicone-covered stent for treatment of refractory benign esophageal strictures. GastrointestEndosc 6:513–519

    Google Scholar 

  5. Verstegen MHP, Bouwense SAW, van Workum F, Ten Broek R, Siersema PD, Rovers M, Rosman C (2019) Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: a systematic review. World J EmergSurg 4(14):17

    Article  Google Scholar 

  6. Kim JH, Song HY, Choi EK, Kim KR, Shin JH, Lim JO (2009) Temporary metallic stent placement in the treatment of refractory benign esophageal strictures: results and factors associated with outcome in 55 patients. EurRadiol 19:384–390

    Google Scholar 

  7. Dua KS, Vleggaar FP, Santharam R, Siersema PD (2008) 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 103:2988–2994

    Article  Google Scholar 

  8. van Heel NC, Haringsma J, Spaander MC, Bruno MJ, Kuipers EJ (2010) Short-term esophageal stenting in the management of benign perforations. Am J Gastroenterol 105:1515–1520

    Article  Google Scholar 

  9. Repici A, Hassan C, Sharma P, Conio M, Siersema P (2010) Systematic review: the role of self-expanding plastic stents for benign oesophageal strictures. Aliment PharmacolTher 31:1268–1275

    Article  CAS  Google Scholar 

  10. Canena JM, Liberato MJ, Rio-Tinto RA, Pinto-Marques PM, Romão CM, Coutinho AV, Neves BA, Santos-Silva MF (2012) A comparison of the temporary placement of 3 different self-expanding stents for the treatment of refractory benign esophageal strictures: a prospective multicentre study. BMC Gastroenterol 12(12):70

    Article  Google Scholar 

  11. Zhao H, Zhou Y, Feng J, Wang W, Mei Y (2016) Literature analysis of the treatment of benign esophageal disease with stent. Indian J Surg 78:6–13

    Article  Google Scholar 

  12. Fuccio L, Hassan C, Frazzoni L, Miglio R, Repici A (2016) Clinical outcomes following stent placement in refractory benign esophageal stricture: a systematic review and meta-analysis. Endoscopy 48:141–148

    PubMed  Google Scholar 

  13. Spaander MC, Baron TH, Siersema PD, Fuccio L, Schumacher B, Escorsell À, Garcia-Pagán JC, Dumonceau JM, Conio M, de Ceglie A, Skowronek J, Nordsmark M, Seufferlein T, Van Gossum A, Hassan C, Repici A, Bruno MJ (2016) Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 48:939–948

    Article  Google Scholar 

  14. Kochman ML, McClave SA, Boyce HW (2005) The refractory and the recurrent esophageal stricture: a definition. GastrointestEndosc 62:474–475

    Google Scholar 

  15. Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, Mergener K, Nemcek A Jr, Petersen BT, Petrini JL, Pike IM, Rabeneck L, Romagnuolo J, Vargo JJ (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. GastrointestEndosc 71:446–454

    Google Scholar 

  16. https://www.britishpainsociety.org/british-pain-society-publications/pain-scales-in-multiple-languages

  17. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the eastern cooperative oncology group. Am J ClinOncol 5:649–655

    Article  CAS  Google Scholar 

  18. Repici A, Small AJ, Mendelson A, Jovani M, Correale L, Hassan C, Ridola L, Anderloni A, Ferrara EC, Kochman ML (2016) Natural history and management of refractorybenign esophageal strictures. GastrointestEndosc 84:222–228

    Google Scholar 

  19. Profili S, Meloni GB, Feo CF, Pischedda A, Bozzo C, Ginesu GC, Canalis GC (2002) Self-expandable metal stents in the management of cervical oesophageal and/or hypopharyngeal strictures. ClinRadiol 57:1028–1033

    CAS  Google Scholar 

  20. Somani SK, Verma N, Avasthi G, Ghosh A, Goyal R, Joshi N (2010) High pharyngoesophageal strictures after laryngopharyngectomy can also be treated by self-expandable plastic stents. GastrointestEndosc 71:1304–1307

    Google Scholar 

  21. Poincloux L, Sautel C, Rouquette O, Pereira B, Goutte M, Bommelaer G, Dapoigny M, Abergel A (2016) The clinical outcome in patients treated with a newly designed SEMS in cervical esophageal strictures and fistulas. J ClinGastroenterol 50:379–387

    CAS  Google Scholar 

  22. Gallo A, Pagliuca G, de Vincentiis M, Martellucci S, Iallonardi E, Fanello G, Cereatti F, Fiocca F (2012) Endoscopic treatment of benign and malignant strictures of the cervical esophagus and hypopharynx. Ann OtolRhinolLaryngol 121:104–109

    Google Scholar 

  23. Conio M, Blanchi S, Filiberti R, Repici A, Barbieri M, Bilardi C, Siersema PD (2007) A modified self-expanding Niti-S stent for the management of benign hypopharyngeal strictures. GastrointestEndosc 65:714–720

    Google Scholar 

  24. Sharma P, Kozarek R (2010) Practice parameters committee of American College of Gastroenterology. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol 105:258–273

    Article  Google Scholar 

  25. Conio M, Repici A, Siersema PD (2011) Self-expandable plastic stents in pharyngoesophageal strictures: a word of caution. GastrointestEndosc 7:642

    Google Scholar 

  26. Pang M, Bartel MJ, Clayton DB, Brahmbhatt B, Woodward TA (2019) Selective application of fully covered biliary stents and narrow-diameter esophageal stents for proximal esophageal indications. Endoscopy 51:169–173

    Article  Google Scholar 

  27. Bechtler M, Wagner F, Fuchs ES, Jakobs R (2015) Biliary metal stents for proximal esophageal or hypopharyngeal strictures. SurgEndosc 29:3205–3208

    Google Scholar 

  28. Thomas S, Siddiqui AA, Taylor LJ, Parbhu S, Cao C, Loren D, Kowalski T, Adler DG (2019) Fully-covered esophageal stent migration rates in benign and malignant disease: a multicenter retrospective study. EndoscInt Open 7:E751–E756

    Article  Google Scholar 

  29. van Halsema EE, Wong Kee Song LM, Baron TH, Siersema PD, Vleggaar FP, Ginsberg GG, Shah PM, Fleischer DE, Ratuapli SK, Fockens P, Dijkgraaf MG, Rando G, Repici A, van Hooft JE (2013) Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases. GastrointestEndosc 77:18–28

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Sanremo General Hospital, Sanremo, IM, Italy

    Massimo Conio, Sabrina Blanchi & Antonella De Ceglie

  2. Department of Gastroenterology, Santa Corona General Hospital, Pietra Ligure, SV, Italy

    Massimo Conio

  3. Clinical Epidemiology Unit, Ospedale Policlinico San Martino, Genova, Italy

    Rosa Angela Filiberti

  4. Department. of Gastroenterology and Hepatology (Route 763), Radboud University Medical Center, Nijmegen, The Netherlands

    Peter D. Siersema

  5. Gastroenterology and Digestive Endoscopy, General Hospital, 06129, Perugia, Italy

    Raffaele Manta

Authors
  1. Massimo Conio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rosa Angela Filiberti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter D. Siersema
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raffaele Manta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sabrina Blanchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonella De Ceglie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Massimo Conio.

Ethics declarations

Disclosure

Drs Massino Conio, Rosa Angela Filiberti, Peter D Siersema, Raffaele Manta, Sabrina Blanchi e Antonella De Ceglie, have no conflict of interest or financial ties to disclosure.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

Appendix A

The ogilvie & atkinson dysphagia score

Grade 0

No dysphagia, able to eat normally

Grade 1

Able to swallow some solid foods

Grade 2

Able to swallow only semisolid foods

Grade 3

Able to swallow liquids only

Grade 4

Aphagia

  1. Mellow LH et al. Arch Intern Med 1985; 145: 1443–6

Appendix B

ECOG performance status

Grade

  1. 0

    Fully active, able to carry on all pre-disease activities without restriction. (KarnofskY 90–100)

  2. 1

    Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework, office work. (Karnofsky 70–80)

  3. 2

    Ambulatory and capable of all self-care, but unable to carry out any work activities. Up and about more than 50 percent of waking hours. (Karnofsky 50–60)

  4. 3

    Capable of only limited self-care, confined to bed or chair 50 percent or more of waking hours. (Karnofsky 30–40)

  5. 4

    Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair. (Karnofsky 10–20)

  6. 5

    Dead

Appendix C

The following data were collected: age, sex, stricture site, prior laryngectomy, date of last radiotherapy with and without chemotherapy, presence of esophago-respiratory or esophago-cutaneous fistula; number of dilation sessions prior stent placement and maximum reached diameter of dilation, presence of feeding tube, percutaneous endoscopic gastrostomy presence, dysphagia score before and after stent placement, weight and albumin serum level at the beginning and at the end of the follow up, length of stenosis, date of stent placement, length and diameter of stent, dilation at the time of stent placement, immediate, early and late AEs, position and degree of expansion of the stent at the esophagography within 24 h after stent placement; date and number of following stent placement, persistent improvement of dysphagia, persisting improvement of stricture, other associated treatment after stent release, Montgomery stent placement, status of patient, and cause of death.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Conio, M., Filiberti, R.A., Siersema, P.D. et al. A new designed self-expandable metal stent for the management of benign radiotherapy-induced hypopharyngeal or cervical esophageal strictures. Surg Endosc 36, 2290–2299 (2022). https://doi.org/10.1007/s00464-021-08504-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08504-z

Keywords

Search

Navigation