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Sabatelle RC, Colson YL, Sachdeva U, Grinstaff MW. Drug Delivery Opportunities in Esophageal Cancer: Current Treatments and Future Prospects. Mol Pharm 2024; 21:3103-3120. [PMID: 38888089 DOI: 10.1021/acs.molpharmaceut.4c00246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
With one of the highest mortality rates of all malignancies, the 5-year survival rate for esophageal cancer is under 20%. Depending on the stage and extent of the disease, the current standard of care treatment paradigm includes chemotherapy or chemoradiotherapy followed by surgical esophagogastrectomy, with consideration for adjuvant immunotherapy for residual disease. This regimen has high morbidity, due to anatomic changes inherent in surgery, the acuity of surgical complications, and off-target effects of systemic chemotherapy and immunotherapy. We begin with a review of current treatments, then discuss new and emerging targets for therapies and advanced drug delivery systems. Recent and ongoing preclinical and early clinical studies are evaluating traditional tumor targets (e.g., human epidermal growth factor receptor 2), as well as promising new targets such as Yes-associated protein 1 or mammalian target of rapamycin to develop new treatments for this disease. Due the function and location of the esophagus, opportunities also exist to pair these treatments with a drug delivery strategy to increase tumor targeting, bioavailability, and intratumor concentrations, with the two most common delivery platforms being stents and nanoparticles. Finally, early results with antibody drug conjugates and chimeric antigenic receptor T cells show promise as upcoming therapies. This review discusses these innovations in therapeutics and drug delivery in the context of their successes and failures, with the goal of identifying those solutions that demonstrate the most promise to shift the paradigm in treating this deadly disease.
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Affiliation(s)
- Robert C Sabatelle
- Departments of Biomedical Engineering and Chemistry, Boston University, Boston, Massachusetts 02215, United States
| | - Yolonda L Colson
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
| | - Uma Sachdeva
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
| | - Mark W Grinstaff
- Departments of Biomedical Engineering and Chemistry, Boston University, Boston, Massachusetts 02215, United States
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Yang Y, Yang Y, Hou Z, Wang T, Wu P, Shen L, Li P, Zhang K, Yang L, Sun S. Comprehensive review of materials, applications, and future innovations in biodegradable esophageal stents. Front Bioeng Biotechnol 2023; 11:1327517. [PMID: 38125305 PMCID: PMC10731276 DOI: 10.3389/fbioe.2023.1327517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Esophageal stricture (ES) results from benign and malignant conditions, such as uncontrolled gastroesophageal reflux disease (GERD) and esophageal neoplasms. Upper gastrointestinal endoscopy is the preferred diagnostic approach for ES and its underlying causes. Stent insertion using an endoscope is a prevalent method for alleviating or treating ES. Nevertheless, the widely used self-expandable metal stents (SEMS) and self-expandable plastic stents (SEPS) can result in complications such as migration and restenosis. Furthermore, they necessitate secondary extraction in cases of benign esophageal stricture (BES), rendering them unsatisfactory for clinical requirements. Over the past 3 decades, significant attention has been devoted to biodegradable materials, including synthetic polyester polymers and magnesium-based alloys, owing to their exceptional biocompatibility and biodegradability while addressing the challenges associated with recurring procedures after BES resolves. Novel esophageal stents have been developed and are undergoing experimental and clinical trials. Drug-eluting stents (DES) with drug-loading and drug-releasing capabilities are currently a research focal point, offering more efficient and precise ES treatments. Functional innovations have been investigated to optimize stent performance, including unidirectional drug-release and anti-migration features. Emerging manufacturing technologies such as three-dimensional (3D) printing and new biodegradable materials such as hydrogels have also contributed to the innovation of esophageal stents. The ultimate objective of the research and development of these materials is their clinical application in the treatment of ES and other benign conditions and the palliative treatment of malignant esophageal stricture (MES). This review aimed to offer a comprehensive overview of current biodegradable esophageal stent materials and their applications, highlight current research limitations and innovations, and offer insights into future development priorities and directions.
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Affiliation(s)
- Yaochen Yang
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
- Research Center for Biomedical Materials, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuanyuan Yang
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhipeng Hou
- Research Center for Biomedical Materials, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tingting Wang
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Wu
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lufan Shen
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Li
- Liaoning Research Institute for Eugenic Birth and Fertility, China Medical University, Shenyang, China
| | - Kai Zhang
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liqun Yang
- Research Center for Biomedical Materials, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
- Liaoning Research Institute for Eugenic Birth and Fertility, China Medical University, Shenyang, China
| | - Siyu Sun
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
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Futuristic Developments and Applications in Endoluminal Stenting. Gastroenterol Res Pract 2022; 2022:6774925. [PMID: 35069729 PMCID: PMC8767390 DOI: 10.1155/2022/6774925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
Endoscopic stenting is a well-established option for the treatment of malignant obstruction, temporary management of benign strictures, and sealing transmural defects, as well as drainage of pancreatic fluid collections and biliary obstruction. In recent years, in addition to expansion in indications for endoscopic stenting, considerable strides have been made in stent technology, and several types of devices with advanced designs and materials are continuously being developed. In this review, we discuss the important developments in stent designs and novel indications for endoluminal and transluminal stenting. Our discussion specifically focuses on (i) biodegradable as well as (ii) irradiating and drug-eluting stents for esophageal, gastroduodenal, biliary, and colonic indications, (iii) endoscopic stenting in inflammatory bowel disease, and (iv) lumen-apposing metal stent.
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Chytrosz P, Golda-Cepa M, Wlodarczyk J, Kuzdzal J, El Fray M, Kotarba A. Characterization of Partially Covered Self-Expandable Metallic Stents for Esophageal Cancer Treatment: In Vivo Degradation. ACS Biomater Sci Eng 2021; 7:1403-1413. [PMID: 33709689 PMCID: PMC8045022 DOI: 10.1021/acsbiomaterials.0c01773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Partially covered self-expandable metallic esophageal stent (SEMS) placement is the most frequently applied palliative treatment in esophageal cancer. Structural characterization of explanted 16 nitinol-polyurethane SEMS (the group of 6 females, 10 males, age 40-80) was performed after their removal due to dysfunction. The adverse bulk changes in the polymer structure were identified using differential scanning calorimetry (DSC), differential mechanical thermal analysis (DMTA), and attenuated total reflectance infrared spectroscopy (ATR-IR) and discussed in terms of melting point shift (9 °C), glass-transition shift (4 °C), differences in viscoelastic behavior, and systematic decrease of peaks intensities corresponding to C-H, C═O, and C-N polyurethane structural bonds. The scanning electron and confocal microscopic observations revealed all major types of surface degradation, i.e., surface cracks, peeling off of the polymer material, and surface etching. The changes in the hydrophobic polyurethane surfaces were also revealed by a significant decrease in wettability (74°) and the corresponding increase of the surface free energy (31 mJ/m2). To understand the in vivo degradation, the in vitro tests in simulated salivary and gastric fluids were performed, which mimic the environments of proximal and distal ends, respectively. It was concluded that the differences in the degradation of the proximal and distal ends of prostheses strongly depend on the physiological environment, in particular stomach content. Finally, the necessity of the in vivo tests for SEMS degradation is pointed out.
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Affiliation(s)
- Paulina Chytrosz
- Faculty of Chemistry, Jagiellonian University, 31-007 Kraków, Poland
| | - Monika Golda-Cepa
- Faculty of Chemistry, Jagiellonian University, 31-007 Kraków, Poland
| | - Janusz Wlodarczyk
- Department of Thoracic and Surgical Oncology, Jagiellonian University Medical College, John Paul II Hospital, 30-387 Kraków, Poland
| | - Jarosław Kuzdzal
- Department of Thoracic and Surgical Oncology, Jagiellonian University Medical College, John Paul II Hospital, 30-387 Kraków, Poland
| | - Miroslawa El Fray
- Department of Polymer and Biomaterials Science, West Pomeranian University of Technology, 70-310 Szczecin, Poland
| | - Andrzej Kotarba
- Faculty of Chemistry, Jagiellonian University, 31-007 Kraków, Poland
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Fouladian P, Jin Q, Arafat M, Song Y, Guo X, Blencowe A, Garg S. Drug-Loaded, Polyurethane Coated Nitinol Stents for the Controlled Release of Docetaxel for the Treatment of Oesophageal Cancer. Pharmaceuticals (Basel) 2021; 14:ph14040311. [PMID: 33915787 PMCID: PMC8067330 DOI: 10.3390/ph14040311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022] Open
Abstract
For several decades, self-expanding metal stents (SEMSs) have shown significant clinical success in the palliation of obstructive metastatic oesophageal cancer. However, these conventional oesophageal stents can suffer from stent blockage caused by malignant tumour cell growth. To overcome this challenge, there is growing interest in drug-releasing stents that, in addition to palliation, provide a sustained and localized release of anticancer drugs to minimise tumour growth. Therefore, in this study we prepared and evaluated an oesophageal stent-based drug delivery platform to provide the sustained release of docetaxel (DTX) for the treatment of oesophageal cancer-related obstructions. The DTX-loaded oesophageal stents were fabricated via dip-coating of bare nitinol stents with DTX-polyurethane (PU) solutions to provide PU coated stents with DTX loadings of 1.92 and 2.79% w/w. Mechanical testing of the DTX-PU coated stents revealed that an increase in the drug loading resulted in a reduction in the ultimate tensile strength, toughness and Young’s modulus. In vitro release studies showed a sustained release of DTX, with ~80–90% released over a period of 33 days. While the DTX-loaded stents exhibited good stability to gamma radiation sterilisation, UV sterilisation or accelerated storage at elevated temperatures (40 °C) resulted in significant DTX degradation. Cell proliferation, apoptosis and Western blotting assays revealed that the DTX released from the stents had comparable anticancer activity to pure DTX against oesophageal cancer cells (KYSE-30). This research demonstrates that the dip-coating technique can be considered as a promising approach for the fabrication of drug-eluting stents (DESs) for oesophageal cancer treatment.
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Affiliation(s)
- Paris Fouladian
- Pharmaceutical Innovation and Development (PIDG) Group, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (P.F.); (M.A.); (Y.S.)
| | - Qiuyang Jin
- Key Laboratory of Chemical Biology (Ministry of Education), Department of Pharmacology, School of Pharmaceutical Sciences, Shandong University, Jinan 250012, China;
| | - Mohammad Arafat
- Pharmaceutical Innovation and Development (PIDG) Group, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (P.F.); (M.A.); (Y.S.)
| | - Yunmei Song
- Pharmaceutical Innovation and Development (PIDG) Group, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (P.F.); (M.A.); (Y.S.)
| | - Xiuli Guo
- Key Laboratory of Chemical Biology (Ministry of Education), Department of Pharmacology, School of Pharmaceutical Sciences, Shandong University, Jinan 250012, China;
- Correspondence: (X.G.); (A.B.); (S.G.)
| | - Anton Blencowe
- Applied Chemistry and Translational Biomaterials (ACTB) Group, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
- Correspondence: (X.G.); (A.B.); (S.G.)
| | - Sanjay Garg
- Pharmaceutical Innovation and Development (PIDG) Group, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (P.F.); (M.A.); (Y.S.)
- Correspondence: (X.G.); (A.B.); (S.G.)
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Influence of Polymer Composition on the Controlled Release of Docetaxel: A Comparison of Non-Degradable Polymer Films for Oesophageal Drug-Eluting Stents. Pharmaceutics 2020; 12:pharmaceutics12050444. [PMID: 32403329 PMCID: PMC7284596 DOI: 10.3390/pharmaceutics12050444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022] Open
Abstract
Following the huge clinical success of drug-eluting vascular stents, there is a significant interest in the development of drug-eluting stents for other applications, such as the treatment of gastrointestinal (GI) cancers. Central to this process is understanding how particular drugs are released from stent coatings, which to a large extent is controlled by drug-polymer interactions. Therefore, in this study we investigated the release of docetaxel (DTX) from a selection of non-degradable polymer films. DTX-polymer films were prepared at various loadings (1, 5 and 10% w/w) using three commercially available polymers including poly(dimethylsiloxane) (PSi), poly (ethylene-co-vinyl acetate) (PEVA) and Chronosil polyurethane (PU). The formulations were characterised using different techniques such as photoacoustic Fourier-transform infrared (PA-FTIR) spectrophotometry, X-ray diffraction (XRD) and differential scanning calorimetry (DSC). The effect of DTX on the mechanical properties of the films, in-vitro release, and degradation tests were also assessed. For all polymers and DTX loadings, the drug was found to disperse homogenously without crystallisation within the polymer matrix. While no specific interactions were observed between DTX and PSi or PEVA, hydrogen-bonding appeared to be present between DTX and PU, which resulted in a concentration-dependent decrease in the Young’s moduli of the films due to disruption of inter-polymeric molecular interactions. In addition, the DTX-PU interactions were found to modulate drug release, providing near-linear release over 30 days, which was accompanied by a significant reduction in degradation products. The results indicate that DTX-loaded PU films are excellent candidates for drug-eluting stents for the treatment of oesophageal cancer.
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Beshchasna N, Saqib M, Kraskiewicz H, Wasyluk Ł, Kuzmin O, Duta OC, Ficai D, Ghizdavet Z, Marin A, Ficai A, Sun Z, Pichugin VF, Opitz J, Andronescu E. Recent Advances in Manufacturing Innovative Stents. Pharmaceutics 2020; 12:E349. [PMID: 32294908 PMCID: PMC7238261 DOI: 10.3390/pharmaceutics12040349] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular diseases are the most distributed cause of death worldwide. Stenting of arteries as a percutaneous transluminal angioplasty procedure became a promising minimally invasive therapy based on re-opening narrowed arteries by stent insertion. In order to improve and optimize this method, many research groups are focusing on designing new or improving existent stents. Since the beginning of the stent development in 1986, starting with bare-metal stents (BMS), these devices have been continuously enhanced by applying new materials, developing stent coatings based on inorganic and organic compounds including drugs, nanoparticles or biological components such as genes and cells, as well as adapting stent designs with different fabrication technologies. Drug eluting stents (DES) have been developed to overcome the main shortcomings of BMS or coated stents. Coatings are mainly applied to control biocompatibility, degradation rate, protein adsorption, and allow adequate endothelialization in order to ensure better clinical outcome of BMS, reducing restenosis and thrombosis. As coating materials (i) organic polymers: polyurethanes, poly(ε-caprolactone), styrene-b-isobutylene-b-styrene, polyhydroxybutyrates, poly(lactide-co-glycolide), and phosphoryl choline; (ii) biological components: vascular endothelial growth factor (VEGF) and anti-CD34 antibody and (iii) inorganic coatings: noble metals, wide class of oxides, nitrides, silicide and carbide, hydroxyapatite, diamond-like carbon, and others are used. DES were developed to reduce the tissue hyperplasia and in-stent restenosis utilizing antiproliferative substances like paclitaxel, limus (siro-, zotaro-, evero-, bio-, amphi-, tacro-limus), ABT-578, tyrphostin AGL-2043, genes, etc. The innovative solutions aim at overcoming the main limitations of the stent technology, such as in-stent restenosis and stent thrombosis, while maintaining the prime requirements on biocompatibility, biodegradability, and mechanical behavior. This paper provides an overview of the existing stent types, their functionality, materials, and manufacturing conditions demonstrating the still huge potential for the development of promising stent solutions.
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Affiliation(s)
- Natalia Beshchasna
- Fraunhofer Institute for Ceramic Technologies and Systems IKTS, Maria-Reiche-Str. 2, 01109 Dresden, Germany; (M.S.); (J.O.)
| | - Muhammad Saqib
- Fraunhofer Institute for Ceramic Technologies and Systems IKTS, Maria-Reiche-Str. 2, 01109 Dresden, Germany; (M.S.); (J.O.)
| | | | - Łukasz Wasyluk
- Balton Sp. z o.o. Modlińska 294, 03-152 Warsaw, Poland; (H.K.); (Ł.W.)
| | - Oleg Kuzmin
- VIP Technologies, Prospect Academicheskiy 8/2, 634055 Tomsk, Russia;
| | - Oana Cristina Duta
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
| | - Denisa Ficai
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
| | - Zeno Ghizdavet
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
| | - Alexandru Marin
- Department of Hydraulics, Hydraulic Machinery and Environmental Engineering, Faculty of Power Engineering, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania;
| | - Anton Ficai
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
- Academy of Romanian Scientists, Spl. Independentei 54, 050094 Bucharest, Romania
| | - Zhilei Sun
- Research School of High-Energy Physics, Tomsk Polytechnic University, Lenin Avenue 30, 634050 Tomsk, Russia;
| | - Vladimir F. Pichugin
- Research School of High-Energy Physics, Tomsk Polytechnic University, Lenin Avenue 30, 634050 Tomsk, Russia;
| | - Joerg Opitz
- Fraunhofer Institute for Ceramic Technologies and Systems IKTS, Maria-Reiche-Str. 2, 01109 Dresden, Germany; (M.S.); (J.O.)
| | - Ecaterina Andronescu
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
- Academy of Romanian Scientists, Spl. Independentei 54, 050094 Bucharest, Romania
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Arafat M, Fouladian P, Blencowe A, Albrecht H, Song Y, Garg S. Drug-eluting non-vascular stents for localised drug targeting in obstructive gastrointestinal cancers. J Control Release 2019; 308:209-231. [DOI: 10.1016/j.jconrel.2019.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 02/08/2023]
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A Review of Self-Expanding Esophageal Stents for the Palliation Therapy of Inoperable Esophageal Malignancies. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9265017. [PMID: 31080835 PMCID: PMC6475558 DOI: 10.1155/2019/9265017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/09/2019] [Accepted: 03/17/2019] [Indexed: 02/07/2023]
Abstract
Esophageal cancer is a very deadly disease, killing more than 15,000 people in the United States annually. Almost 400,000 new cases happen in the worldwide every year. More than 50% esophageal cancer patients are diagnosed at an advanced stage when they need an esophageal stent to open the blocked esophagus for feeding and drinking. Esophageal stents have evolved in stages over the years. Current clinically used stents commonly include stainless steel or nitinol self-expandable metallic stent (SEMS) and self-expandable plastic stent (SEPS). There are many choices of different types of stents and sizes, with fierce competition among manufacturers. However, current stent technology, whether uncovered, partially covered, fully covered SEMS or SEPS, has their own advantages to solve the dysphagia, stricture, and fistula problems, but they also cause some clinical complications. The ideal stent remains elusive. New 3D printing technique may bring new promising potential to manufacturing personalized esophageal stents. Drug-eluting stents could be the new avenue to do more than just pry open a stricture or cover a defect in the esophageal lumen, a possibility of proving local anticancer therapy simultaneously. Additionally, the lack of esophageal cancer animal models also hinders the progress of stent development. This paper reviews these topics for a comprehensive understanding of this field. In a conclusion, the ultimate goal of the future esophageal stent would have multifunction to treat the underlying conditions and restore esophageal function to near normal.
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Abstract
Background The aim of this study was to analyze the safety and effectiveness of stenting using partially covered self-expandable stents in palliation of dysphagia in patients with unresectable esophageal cancer. Methods Retrospective analysis of hospital records of all patients who underwent esophageal stenting in the period 2008–2015 was performed. The study included patients with unresectable esophageal and esophagogastric cancer. Results There were 442 patients included. Mean age was 56 years (range 28–89), and 379 were males. In 40 (9.0%) patients, stenting was performed in the cervical, in 150 (39.3%)—in the middle thoracic, in 141 (31.9%)—in lower thoracic esophagus and in 111 (25.1%)—in the esophagogastric junction. Stenting resulted in significant alleviation of dysphagia grade (3.0 vs. 1.0, p = 0.00001). During the follow-up, 55 (12.4%) patients experienced recurrent dysphagia due to tumor or granulation tissue overgrowth, and in 18 (4.1%) patients, migration of the stent occurred, for which an independent risk factor was adjuvant chemo- and/or radiation therapy (p = 0.001). Minor complications included chest pain (54.5%), delayed complete stent expansion (12.0%), feeling of a foreign body (25.3%), hiccup (1.6%), gastroesophageal reflux (45.6%) and post-discharge pneumonia (2.5%). A feeling of a foreign body in the esophagus was significantly more common after stenting of the cervical esophagus (p = 0.0001), and hiccup was more common after stenting of the esophagogastric junction (p = 0.02). Major complications included bleeding (1.3%), respiratory insufficiency (0.7%), esophageal perforation (0.9%) and irregular heartburn (2.3%). Overall procedure-related mortality was 0.4%. The median survival time was 117.8 days (range 2–732). Conclusions Stenting is an effective procedure in relieving dysphagia in patients with unresectable malignant esophageal stenosis and is associated with low rate of postoperative and long-term complications.
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Affiliation(s)
- Janusz R Włodarczyk
- Department of Thoracic and Surgical Oncology, Jagiellonian University Collegium Medicum, John Paul II Hospital, Kraków, Poland. .,Department of Thoracic Surgery, John Paul II Hospital, ul. Prądnicka 80, 31-202, Kraków, Poland.
| | - Jarosław Kużdżał
- Department of Thoracic and Surgical Oncology, Jagiellonian University Collegium Medicum, John Paul II Hospital, Kraków, Poland.,Department of Thoracic Surgery, John Paul II Hospital, ul. Prądnicka 80, 31-202, Kraków, Poland
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Mozafari H, Dong P, Zhao S, Bi Y, Han X, Gu L. Migration resistance of esophageal stents: The role of stent design. Comput Biol Med 2018; 100:43-49. [PMID: 29975854 DOI: 10.1016/j.compbiomed.2018.06.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Stenting is one of the major treatments for malignant esophageal cancer. However, stent migration compromises clinical outcomes. A flared end design of the stent diminishes its migration. The goal of this work is to quantitatively characterize stent migration to develop new strategies for better clinical outcomes. METHODS An esophageal stent with flared ends and a straight counterpart were virtually deployed in an esophagus with asymmetric stricture using the finite element method. The resulted esophagus shape, wall stress, and migration resistance force of the stent were quantified and compared. RESULTS The lumen gain for both the flared stent and the straight one exhibited no significant difference. The flared stent induced a significantly larger contact force and thus a larger stress onto the esophagus wall. In addition, more migration resistance force was required to pull the flared stent through the esophagus. This force was inversely related to the occurrence rate of stent migration. A doubled strut diameter also increased the migration resistance force by approximately 56%. An increased friction coefficient from 0.1 to 0.3 also boosted the migration resistance force by approximately 39%. SUMMARY The mechanical advantage of the flared stent was unveiled by the significantly increased contact force, which provided the anchoring effect to resist stent migration. Both the strut diameter and friction coefficient positively correlated with the migration resistance force, and thus the occurrence of stent migration.
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Affiliation(s)
- Hozhabr Mozafari
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588-0656, USA
| | - Pengfei Dong
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588-0656, USA
| | - Shijia Zhao
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588-0656, USA
| | - Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan Province, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan Province, China.
| | - Linxia Gu
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588-0656, USA; Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan Province, China; Nebraska Center for Materials and Nanoscience, Lincoln, NE, 68588-0656, USA.
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Jin Z, Wu K, Hou J, Yu K, Shen Y, Guo S. A PTX/nitinol stent combination with temperature-responsive phase-change 1-hexadecanol for magnetocaloric drug delivery: Magnetocaloric drug release and esophagus tissue penetration. Biomaterials 2018; 153:49-58. [DOI: 10.1016/j.biomaterials.2017.10.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 01/12/2023]
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History of the Use of Esophageal Stent in Management of Dysphagia and Its Improvement Over the Years. Dysphagia 2017; 32:39-49. [PMID: 28101666 DOI: 10.1007/s00455-017-9781-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/01/2017] [Indexed: 01/07/2023]
Abstract
The art and science of using stents to treat dysphagia and seal fistula, leaks and perforations has been evolving. Lessons learnt from the deficiencies of previous models led to several improvements making stent deployment easier, and with some designs, it was also possible to remove the stents if needed. With these improvements, besides malignant dysphagia, newer indications for using stents emerged. Unfortunately, despite several decades of evolution, as yet, there is no perfect stent that "fits all." This article is an overview of how this evolution process happened and where we are currently with using stents to manage patients with dysphagia and with other esophageal disorders.
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14
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Shaikh M, Zhang H, Wang H, Guo X, Song Y, Kanwar JR, Garg S. In Vitro and In Vivo Assessment of Docetaxel Formulation Developed for Esophageal Stents. AAPS PharmSciTech 2017; 18:130-137. [PMID: 26895019 DOI: 10.1208/s12249-016-0501-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/08/2016] [Indexed: 12/13/2022] Open
Abstract
Esophageal cancer (EC) mostly affects the elderly population and is frequently diagnosed at an advanced stage. Self-expanding metal stents (SEMS) are the most popular mode of palliation, but they are associated with reocclusion caused by tumor growth. To overcome this problem, docetaxel (DTX)-loaded polyurethane formulations were prepared for stent application. The films were evaluated against the cancer cell lines, OE-19 and OE-21, and normal esophageal cell line Het-1A. The DTX and the formulations were evaluated in vitro for the cytotoxicity and in vivo in nude mice. It was found that DTX and the formulations have a weak activity against the EC cell lines and an even weaker activity against Het-1A cell line. Preliminary in vivo studies showed skin toxicity in nude mice necessitating modification of the formulation. Reevaluation in a mouse xenograft model resulted in toxicity at high dose formulations while the low dose formulation exhibited modest advantage over commercial IV formulation; however, there was no significant difference between the commercial IV and blank formulation. DTX combination with an anti-cancer agent having complementary mode of action and non-overlapping toxicity could yield better outcome in future.
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Affiliation(s)
- Mohsin Shaikh
- Centre for Pharmaceutical Innovation and Development (CPID), School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, 5000, Australia
| | - Huihui Zhang
- Department of Pharmacology, School of Pharmaceutical Sciences, Shandong University, Jinan, 250100, People's Republic of China
| | - Hongyuan Wang
- Department of Pharmacology, School of Pharmaceutical Sciences, Shandong University, Jinan, 250100, People's Republic of China
| | - Xiuli Guo
- Department of Pharmacology, School of Pharmaceutical Sciences, Shandong University, Jinan, 250100, People's Republic of China
| | - Yunmei Song
- Centre for Pharmaceutical Innovation and Development (CPID), School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, 5000, Australia
| | - Jagat Rakesh Kanwar
- Nanomedicine-Laboratory of Immunology and Molecular Biomedical Research, School of Medicine, Faculty of Health, Centre for Molecular and Medical Research, Deakin University, Pigdons Road, Waurn Ponds, Geelong, Victoria, 3216, Australia
| | - Sanjay Garg
- Centre for Pharmaceutical Innovation and Development (CPID), School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, 5000, Australia.
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Yang K, Ling C, Yuan T, Zhu Y, Cheng Y, Cui W. Polymeric Biodegradable Stent Insertion in the Esophagus. Polymers (Basel) 2016; 8:E158. [PMID: 30979258 PMCID: PMC6432023 DOI: 10.3390/polym8050158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/03/2016] [Accepted: 04/08/2016] [Indexed: 12/11/2022] Open
Abstract
Esophageal stent insertion has been used as a well-accepted and effective alternative to manage and improve the quality of life for patients diagnosed with esophageal diseases and disorders. Current stents are either permanent or temporary and are fabricated from either metal or plastic. The partially covered self-expanding metal stent (SEMS) has a firm anchoring effect and prevent stent migration, however, the hyperplastic tissue reaction cause stent restenosis and make it difficult to remove. A fully covered SEMS and self-expanding plastic stent (SEPS) reduced reactive hyperplasia but has a high migration rate. The main advantage that polymeric biodegradable stents (BDSs) have over metal or plastic stents is that removal is not require and reduce the need for repeated stent insertion. But the slightly lower radial force of BDS may be its main shortcoming and a post-implant problem. Thus, strengthening support of BDS is a content of the research in the future. BDSs are often temporarily effective in esophageal stricture to relieve dysphagia. In the future, it can be expect that biodegradable drug-eluting stents (DES) will be available to treat benign esophageal stricture, perforations or leaks with additional use as palliative modalities for treating malignant esophageal stricture, as the bridge to surgery or to maintain luminal patency during neoadjuvant chemoradiation.
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Affiliation(s)
- Kai Yang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yi Shan Road, Shanghai 200233, China.
| | - Christopher Ling
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Soochow University, 708 Renmin Road, Suzhou 215006, China.
- Nanotechnology Engineering, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada.
| | - Tianwen Yuan
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yi Shan Road, Shanghai 200233, China.
| | - Yueqi Zhu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yi Shan Road, Shanghai 200233, China.
| | - Yingsheng Cheng
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yi Shan Road, Shanghai 200233, China.
| | - Wenguo Cui
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Soochow University, 708 Renmin Road, Suzhou 215006, China.
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16
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Effect of polymer microstructure on the docetaxel release and stability of polyurethane formulation. Eur J Pharm Biopharm 2016; 101:82-9. [PMID: 26829379 DOI: 10.1016/j.ejpb.2016.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/12/2015] [Accepted: 01/20/2016] [Indexed: 11/20/2022]
Abstract
PurSil®AL20 (PUS), a copolymer of 4,4'-dicyclohexylmethane diisocyanate (HMDI), 1,4-butane diol (BD), poly-tetramethylene oxide (PTMO) and poly-dimethyl siloxane (PDMS) was investigated for stability as a vehicle for Docetaxel (DTX) delivery through oesophageal drug eluting stent (DES). On exposure to stability test conditions, it was found that DTX release rate declined at 4 and 40 °C. In order to divulge reasons underlying this, changes in DTX solid state as well as PUS microstructure were followed. It was found that re-crystallization of DTX in PDMS rich regions was reducing the drug release at both 4 °C and 40 °C samples. So far microstructural features have not been correlated with stability and drug release, and in this study we found that at 40 °C increase in microstructural domain sizes and the inter-domain distances (from ∼85 Å to 129 Å) were responsible for hindering the DTX release in addition to DTX re-crystallization.
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