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.
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References
Schembre DB. Recent advances in the use of stents for esophageal disease. Gastrointest Endosc Clin N Am. 2010;20:103–21.
Mohan V, Kozarek RA. Placement of conventional and expandable stents for malignant esophageal stenoses. Tech Gastrointest Endosc. 2001;3: 166–75.
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.
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.
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.
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.
Langer FB, Zacherl J. Palliative endoscopic interventions in esophageal cancer. Eur Surg. 2007;39: 288–94.
Siersema PD. New developments in palliative therapy. Best Pract Res Clin Gastroenterol. 2006;20:959–78.
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.
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.
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.
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.
Ferguson DD. Evaluation and management of benign esophageal strictures. Dis Esophagus. 2005;18:359–64.
Lew RJ, Kochman ML. A review of endoscopic methods of esophageal dilation. J Clin Gastroenterol. 2002;35:117–26.
Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc. 2005;62:474–5.
Thomas T, Abrams KR, Subramanian V, et al. Esophageal stents for benign refractory strictures: a meta-analysis. Endoscopy. 2011;43:386–93.
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.
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.
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.
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.
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.
Baron TH. Role of endoscopy in the management of esophageal diseases. Minerva Gastroenterol Dietol. 2008;54:415–27.
Schembre D. Advances in esophageal stenting: the evolution of fully covered stents for malignant and benign disease. Adv Ther. 2010;27:413–25.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med. 2001;344:1681–7.
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.
Rao C, Haycock A, Zacharakis E, et al. Economic analysis of esophageal stenting for management of malignant dysphagia. Dis Esophagus. 2009;22:337–47.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Dua KS, Kozarek R, Kim J, et al. Self-expanding metal esophageal stent with anti-reflux mechanism. Gastrointest Endosc. 2001;53:603–13.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Vleggaar FP. Stent placement in esophageal cancer as a bridge to surgery. Gastrointest Endosc. 2009;70:620–2.
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.
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.
Irani S, Kozarek R. Esophageal stents: past, present, and future. Tech Gastrointest Endosc. 2010;12:178–90.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Further Reading
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.
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.
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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
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