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Boregowda U, Goyal H, Mann R, Gajendran M, Patel S, Echavarria J, Sayana H, Saligram S. Endoscopic management of benign recalcitrant esophageal strictures. Ann Gastroenterol 2021; 34:287-299. [PMID: 33948052 PMCID: PMC8079876 DOI: 10.20524/aog.2021.0585] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
Abstract
Benign esophageal strictures are one of the common clinical conditions managed by endoscopists. Nearly 90% of the benign esophageal strictures respond to endoscopic dilation. However, a small percentage of patients progress to recalcitrant strictures. The benign recalcitrant esophageal strictures are difficult to manage both medically and endoscopically as they do not respond to conventional treatment with proton pump inhibitors and esophageal dilations. Patients with benign recalcitrant esophageal strictures are at a high risk of developing debilitating malnutrition and morbidity due to severe dysphagia. This condition is associated with psychological trauma to patients as treatments are usually prolonged with poor outcomes. Also, this can be a financial burden on the healthcare industry due to several sessions of treatment. In this article, we discuss the classification of benign esophageal strictures, evidence-based treatment strategies, endoscopic procedural techniques, and complications of endoscopic interventions. We aim to guide providers in managing benign esophageal strictures with a focus on endoscopic management of benign recalcitrant esophageal strictures.
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Affiliation(s)
- Umesha Boregowda
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY (Umesha Boregowda)
| | - Hemant Goyal
- Department of Medicine, The Wright Center for Graduation Medical Center, Scranton, PA (Hemant Goyal)
| | - Rupinder Mann
- Department of Internal Medicine, Saint Agnes Medical Center, Fresno, CA (Rupinder Mann)
| | - Mahesh Gajendran
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX (Mahesh Gajendran)
| | - Sandeep Patel
- Division of Gastroenterology, University of Texas Health, San Antonio, TX (Sandeep Patel, Juan Echavarria, Hari Sayana, Shreyas Saligram), USA
| | - Juan Echavarria
- Division of Gastroenterology, University of Texas Health, San Antonio, TX (Sandeep Patel, Juan Echavarria, Hari Sayana, Shreyas Saligram), USA
| | - Hari Sayana
- Division of Gastroenterology, University of Texas Health, San Antonio, TX (Sandeep Patel, Juan Echavarria, Hari Sayana, Shreyas Saligram), USA
| | - Shreyas Saligram
- Division of Gastroenterology, University of Texas Health, San Antonio, TX (Sandeep Patel, Juan Echavarria, Hari Sayana, Shreyas Saligram), USA
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Abou Ali E, Belle A, Hallit R, Terris B, Beuvon F, Leconte M, Dohan A, Leblanc S, Dermine S, Palmieri LJ, Coriat R, Chaussade S, Barret M. Management of esophageal strictures after endoscopic resection for early neoplasia. Therap Adv Gastroenterol 2021; 14:1756284820985298. [PMID: 33519974 PMCID: PMC7816530 DOI: 10.1177/1756284820985298] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/26/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Endoscopic resection of extensive esophageal neoplastic lesions is associated with a high rate of esophageal stricture. Most studies have focused on the risk factors for post-endoscopic esophageal stricture, but data on the therapeutic management of these strictures are scarce. Our aim is to describe the management of esophageal strictures following endoscopic resection for early esophageal neoplasia. METHODS We included all patients with an endoscopic resection for early esophageal neoplasia followed by endoscopic dilatation at a tertiary referral center. We recorded the demographic, endoscopic, and histological characteristics, and the outcomes of the treatment of the strictures. RESULTS Between January 2010 and December 2019, we performed 166 endoscopic mucosal resections and 261 endoscopic submucosal dissections for early esophageal neoplasia, and 34 (8.0%) patients developed an esophageal stricture requiring endoscopic treatment. The indication for endoscopic resection was Barrett's neoplasia in 15/34 (44.1%) cases and squamous cell neoplasia (SCN) in 19/34 (55.9%) cases. The median [(interquartile range) (IQR)] number of endoscopic dilatations was 2.5 (2.0-4.0). Nine of 34 (26.5%) patients required only one dilatation, and 22/34 (65%) had complete dysphagia relief following three endoscopic treatment sessions. The median number of dilatations was significantly higher for SCN [3.0 (2-7); range 1-17; p = 0.02], and in the case of circumferential resection [4.0 (3.0-7.0); p = 0.03]. Endoscopic dilatation allowed a sustained dysphagia relief in 33/34 (97.0%) patients after a mean follow-up of 25.3 ± 22 months. CONCLUSION Refractory post-endoscopic esophageal stricture is a rare event. After a median of 2.5 endoscopic dilatations, 97.0% of patients were permanently relieved of dysphagia. Circumferential endoscopic esophageal resections should be considered when indicated.
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Affiliation(s)
- Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Rachel Hallit
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Benoit Terris
- Department of Pathology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Frédéric Beuvon
- Department of Pathology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Mahaut Leconte
- Department of Digestive Surgery, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris France,University of Paris, Paris, France
| | - Anthony Dohan
- Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Solène Dermine
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Lola-Jade Palmieri
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
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Lumen-apposing Metal Stents, Fully Covered Self-expanding Metal Stents, and Biodegradable Stents in the Management of Benign of GI Strictures: A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2019; 53:560-573. [PMID: 31149932 DOI: 10.1097/mcg.0000000000001228] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Refractory benign gastrointestinal (GI) strictures are difficult to treat and placement of a stent is a commonly sought resort. Stents used for this purpose are fully covered self-expanding metal stent (FCSEMS), a biodegradable stent (BDS) and recently, a lumen-apposing metal stent (LAMS). There is no data comparing these stents to this end. METHODS We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through October 2018) to identify studies that reported on the performance of FCSEMS, BDS, and LAMS in the treatment of refractory benign GI strictures. Our goals were to evaluate the pooled rate of technical success, clinical success, and adverse events with these stents and compare the outcomes between them. RESULTS A total of 31 studies were analyzed. In total, 14 (342 patients), 11 (226 patients), and 8 studies (192 patients) reported the use of FCSEMS, BDS, and LAMS, respectively. The pooled rate of technical success was 96.5% [95% confidence interval (CI): 93.5-98.1], 91.9% (95% CI: 85.6-95.6), and 97.6% (95% CI: 94.0-99.0) with FCSEMS, BDS, and LAMS respectively. No statistical significance to the difference was noted. The pooled rate of clinical success was 48.4% (95% CI: 37.1-59.8), 34.9% (95% CI: 23.6-48.1), and 78.8% (95% CI: 65.8-87.8) with FCSEMS, BDS, and LAMS, respectively. Statistical significance was noted in LAMS versus FCSEMS (P=0.001) and LAMS versus BDS (P=0.001). LAMS demonstrated statistically better outcomes in regards to stent migration and postprocedure pain when compared with FCSEMS and BDS. CONCLUSION Our study demonstrates that LAMS gives better clinical outcomes in the treatment of refractory benign GI strictures when compared with FCSEMS and BDS. Variability in the site, as well as the length of stricture, indirect comparison, and heterogeneity, were the limitations of our study.
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Abstract
OPINION STATEMENT PURPOSE OF REVIEW: Esophageal stents are used in clinical practice for endoscopic treatment of a wide variety of esophageal diseases and conditions. This review provides key principles and a literature update on the utility and limitations of esophageal stenting in clinical practice. RECENT FINDINGS Indications for esophageal stenting can be subdivided into two groups. The first group consists of patients with malignant or benign dysphagia, in which an esophageal stent restores luminal patency. In the past years, temporary stent placement has increasingly been used in the therapeutic management of refractory benign esophageal strictures. When endoscopic repeated bougie dilation and other endoscopic treatment modalities have failed, an esophageal stent could be considered. Based on the literature, a fully covered self-expandable metal stent may be the preferred choice for the treatment of both malignant and benign dysphagia. The second group consists of patients with leakage from the esophageal lumen into the surrounding tissue. Esophageal leakage can be subdivided into three forms, benign esophageal perforations (iatrogenic and spontaneous), anastomotic leakage after reconstructive esophageal surgery, and fistula. In a carefully selected group of patients, a covered esophageal stent may be used for sealing off the leakage, thereby preventing further contamination of the tissue surrounding the defect. The past few years, several validated prediction tools have been developed that may assist clinicians in the selection of patients eligible for esophageal stent placement. Based on retrospective studies and expert opinion, a partially or fully covered self-expandable metal stent may have a role in treatment of esophageal leakage. Research do date supports the utilization of esophageal stents for the treatment of malignant or benign dysphagia and esophageal leakage.
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Affiliation(s)
- Bram D Vermeulen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Geert Grooteplein-Zuid 8 (route 455), 6500, HB, Nijmegen, the Netherlands.
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Geert Grooteplein-Zuid 8 (route 455), 6500, HB, Nijmegen, the Netherlands
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Jung GM, Lee SH, Myung DS, Lee WS, Joo YE, Jung MR, Ryu SY, Park YK, Cho SB. Novel Endoscopic Stent for Anastomotic Leaks after Total Gastrectomy Using an Anchoring Thread and Fully Covering Thick Membrane: Prevention of Embedding and Migration. J Gastric Cancer 2018; 18:37-47. [PMID: 29629219 PMCID: PMC5881009 DOI: 10.5230/jgc.2018.18.e2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/16/2018] [Accepted: 01/29/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose The endoscopic management of a fully covered self-expandable metal stent (SEMS) has been suggested for the primary treatment of patients with anastomotic leaks after total gastrectomy. Embedded stents due to tissue ingrowth and migration are the main obstacles in endoscopic stent management. Materials and Methods The effectiveness and safety of endoscopic management were evaluated for anastomotic leaks when using a benign fully covered SEMS with an anchoring thread and thick silicone covering the membrane to prevent stent embedding and migration. We retrospectively reviewed the data of 14 consecutive patients with gastric cancer and anastomotic leaks after total gastrectomy treated from January 2009 to December 2016. Results The technical success rate of endoscopic stent replacement was 100%, and the rate of complete leaks closure was 85.7% (n=12). The mean size of leaks was 13.1 mm (range, 3-30 mm). The time interval from operation to stent replacement was 10.7 days (range, 3-35 days) and the interval from stent replacement to extraction was 32.3 days (range, 18-49 days). The complication rate was 14.1%, and included a single jejunal ulcer and delayed stricture at the site of leakage. No embedded stent or migration occurred. Two patients died due to progression of pneumonia and septic shock 2 weeks after stent replacement. Conclusions A benign fully covered SEMS with an anchoring thread and thick membrane is an effective and safe stent in patients with anastomotic leaks after total gastrectomy. The novelty of this stent is that it provides complete prevention of stent migration and embedding, compared with conventional fully covered SEMS.
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Affiliation(s)
- Gum Mo Jung
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Seung Hyun Lee
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dae Seong Myung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Wan Sik Lee
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Yeob Ryu
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Young Kyu Park
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Bum Cho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Kim KY, Tsauo J, Song HY, Park JH, Jun EJ, Zhou WZ, Kim MT. Evaluation of a New Esophageal Stent for the Treatment of Malignant and Benign Esophageal Strictures. Cardiovasc Intervent Radiol 2017; 40:1576-1585. [PMID: 28516274 DOI: 10.1007/s00270-017-1677-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 04/28/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Kun Yung Kim
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Jiaywei Tsauo
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Ho-Young Song
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.
| | - Jung-Hoon Park
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
- Biomedical Engineering Center, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Eun Jung Jun
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Wei-Zhong Zhou
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Min Tae Kim
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
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Fully covered self-expanding metallic stent placement for benign refractory esophageal strictures. Indian J Gastroenterol 2017; 36:197-201. [PMID: 28674786 DOI: 10.1007/s12664-017-0764-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 05/11/2017] [Indexed: 02/04/2023]
Abstract
AIMS Treatment options for benign refractory esophageal stricture are limited. We retrospectively analyzed data of 11 patients who underwent fully covered self-expanding metallic stent (FC-SEMS) placement for refractory benign esophageal stricture at our institute. METHODS Refractory benign esophageal stricture was defined as inability to dilate a stricture to a diameter of 14 mm after a minimum of five sessions at 2-week intervals or inability to maintain diameter of 14 mm for at least 4 weeks. Eleven patients with refractory benign esophageal stricture (corrosive-6, peptic-3, and post-sclerotherapy-2) underwent FC-SEMS placement. The stent was removed after 4-6 weeks as per manufacturer's recommendation. Patients were followed up for 1 year. RESULTS Three patients with peptic strictures [length of stricture 2, 3, and 3 cm] and two patients with post-sclerotherapy stricture [length 2 and 1.5 cm] had complete response. Two of 6 patients with corrosive stricture (10 cm, 12 cm) developed recurrence of symptoms within 1 month of stent removal, and two after 2 months (8 cm, 3 cm). One patient with corrosive stricture (6 cm) had recurrence after 6 months, and responded to single session of dilatation. One patient with corrosive stricture was asymptomatic for last 12 months. Four stents were migrated. Four patients developed severe retrosternal pain following stent placement, which was managed with analgesics. There were no serious adverse events after placement of stent and removal of stent. CONCLUSIONS Fully covered SEMS is safe and effective for refractory benign non-corrosive esophageal strictures.
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Poincloux L, Rouquette O, Abergel A. Endoscopic treatment of benign esophageal strictures: a literature review. Expert Rev Gastroenterol Hepatol 2017; 11:53-64. [PMID: 27835929 DOI: 10.1080/17474124.2017.1260002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Benign esophageal strictures arise from various etiologies and are frequently encountered. Although endoscopic dilation is still the first-line therapy, recurrent strictures do occur in approximately 10% of the cases and remains a challenge to gastroenterologists. Areas covered: A literature search was performed using PubMed and Google Scholar databases for original and review articles on endoscopic treatment of benign esophageal strictures. This review outlines the main available treatment options and its controversies in the management of refractory benign esophageal strictures. Expert commentary: Adding local steroid injections to dilation can be effective for peptic stenosis and strictures after endoscopic submucosal dissection, but remains uncertain for anastomotic strictures. Intralesional injections of mitomycin-C could be useful in corrosive strictures. Incisional therapy can be a reliable alternative in Schatzki rings and in anastomotic strictures, in experienced hands. By contrast, long-term outcome with endoprosthetic treatment is disappointing, and stent placement should be carefully considered and individualized.
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Affiliation(s)
- Laurent Poincloux
- a Department of Digestive and Hepatobiliary Diseases , Estaing University Hospital , Clermont-Ferrand , France.,b UMR Auvergne University/CNRS 6284 ISIT (Image Sciences for Innovations Techniques) , Clermont-Ferrand , France
| | - Olivier Rouquette
- a Department of Digestive and Hepatobiliary Diseases , Estaing University Hospital , Clermont-Ferrand , France
| | - Armand Abergel
- a Department of Digestive and Hepatobiliary Diseases , Estaing University Hospital , Clermont-Ferrand , France.,b UMR Auvergne University/CNRS 6284 ISIT (Image Sciences for Innovations Techniques) , Clermont-Ferrand , France
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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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Yuan T, Zheng R, Yu J, Edmonds L, Wu W, Cao J, Gao F, Zhu Y, Cheng Y, Cui W. Fabrication and evaluation of polymer-based esophageal stents for benign esophagus stricture insertion. RSC Adv 2016. [DOI: 10.1039/c5ra23763g] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
In benign esophageal strictures, polymeric lines and membranes were chosen to knit an esophageal stent for relieving esophageal lesions caused by esophageal stenosis and obstruction.
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Affiliation(s)
- Tianwen Yuan
- Orthopedic Institute
- College of Medicine
- Soochow University
- Suzhou
- P. R. China
| | - Reila Zheng
- Orthopedic Institute
- College of Medicine
- Soochow University
- Suzhou
- P. R. China
| | - Jia Yu
- Orthopedic Institute
- College of Medicine
- Soochow University
- Suzhou
- P. R. China
| | - Laura Edmonds
- Orthopedic Institute
- College of Medicine
- Soochow University
- Suzhou
- P. R. China
| | - Wei Wu
- Department of General Surgery
- Yangzhou First Hospital Affiliated to Southeast University
- Yangzhou
- P. R. China
| | - Jun Cao
- Department of Interventional Oncology
- Dahua Hospital
- Shanghai 200237
- China
| | - Fei Gao
- Zhejiang Zylox Medical Device Co., Ltd
- Hangzhou
- P. R. China
| | - Yueqi Zhu
- Department of Radiology
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Shanghai
- P. R. China
| | - Yingsheng Cheng
- Department of Radiology
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Shanghai
- P. R. China
| | - Wenguo Cui
- Orthopedic Institute
- College of Medicine
- Soochow University
- Suzhou
- P. R. China
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Barret M, Beye B, Leblanc S, Beuvon F, Chaussade S, Batteux F, Prat F. Systematic review: the prevention of oesophageal stricture after endoscopic resection. Aliment Pharmacol Ther 2015; 42:20-39. [PMID: 25982288 DOI: 10.1111/apt.13254] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 02/28/2015] [Accepted: 04/30/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Extensive endoscopic resections for the treatment of early oesophageal neoplasia can result in fibro-inflammatory strictures that require repeated interventions, which significantly alter the patients' quality of life. AIMS To review current evidence about the prevention of oesophageal strictures following endoscopic resections. METHODS Systematic search of PubMed and Embase from inception to March 2015 using appropriate keywords. All original publications in English were included, and articles on the treatment of oesophageal stricture were excluded. RESULTS Of the 461 hits, 62 studies were included in the analysis. Among the wound-protective strategies, polyglycolic acid sheets showed the most convincing evidence with a 37.5% stricture rate and excellent safety. Regenerative medicine, using cell sheets of autologous keratinocytes, resulted in a 25% stricture rate, although with cost and availability concerns. Among anti-proliferative treatment modalities, steroid treatment, either endoscopically injected triamcinolone in the resection wound or orally administered prednisolone, proved effective with an overall stricture rate of 13.5%, with safety concerns regarding late oesophageal perforations and infectious morbidity. Among mechanical treatment options, poorly effective and high-risk preventive balloon dilation tend to be replaced by prophylactic covered stent, with 18-28% stricture rates. CONCLUSIONS Although oral or locally injected steroids are promising options, no currently available technique is sufficiently efficient and devoid of significant safety concerns to recommend its routine use for the prevention of strictures after extensive endoscopic resection. Improving our knowledge in the mechanisms of oesophageal wound healing will guide the development of novel methods for stricture prevention.
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Affiliation(s)
- M Barret
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,UI 1016, Faculté Paris Descartes, Paris, France
| | - B Beye
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,UI 1016, Faculté Paris Descartes, Paris, France
| | - S Leblanc
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - F Beuvon
- Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - S Chaussade
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - F Batteux
- UI 1016, Faculté Paris Descartes, Paris, France.,Department of Immunology, Cochin Hospital, Paris, France
| | - F Prat
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,UI 1016, Faculté Paris Descartes, Paris, France
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van Halsema EE, van Hooft JE. Clinical outcomes of self-expandable stent placement for benign esophageal diseases: A pooled analysis of the literature. World J Gastrointest Endosc 2015. [PMID: 25685270 DOI: 10.4253/wjge.v7.i2.135.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIM To analyze the outcomes of self-expandable stent placement for benign esophageal strictures and benign esophageal leaks in the literature. METHODS The PubMed, Embase and Cochrane databases were searched for relevant articles published between January 2000 and July 2014. Eight prospective studies were identified that analyzed the outcomes of stent placement for refractory benign esophageal strictures. The outcomes of stent placement for benign esophageal leaks, perforations and fistulae were extracted from 20 retrospective studies that were published after the inclusion period of a recent systematic review. Data were pooled and analyzed using descriptive statistics. RESULTS Fully covered self-expandable metal stents (FC SEMS) (n = 85), biodegradable (BD) stents (n = 77) and self-expandable plastic stents (SEPS) (n = 70) were inserted in 232 patients with refractory benign esophageal strictures. The overall clinical success rate was 24.2% and according to stent type 14.1% for FC SEMS, 32.9% for BD stents and 27.1% for SEPS. Stent migration occurred in 24.6% of cases. The overall complication rate was 31.0%, including major (17.7%) and minor (13.4%) complications. A total of 643 patients were treated with self-expandable stents mainly for postsurgical leaks (64.5%), iatrogenic perforations (19.6%), Boerhaave's syndrome (7.8%) and fistulae (3.7%). FC SEMS and partially covered SEMS were used in the majority of patients. Successful closure of the defect was achieved in 76.8% of patients and according to etiology in 81.4% for postsurgical leaks, 86.0% for perforations and 64.7% for fistulae. The pooled stent migration rate was 16.5%. Stent-related complications occurred in 13.4% of patients, including major (7.8%) and minor (5.5%) complications. CONCLUSION The outcomes of stent placement for refractory benign esophageal strictures were poor. However, randomized trials are needed to put this into perspective. The evidence on successful stent placement for benign esophageal leaks, perforations and fistulae is promising.
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Affiliation(s)
- Emo E van Halsema
- Emo E van Halsema, Jeanin E van Hooft, Department of Gastroenterology and Hepatology, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Jeanin E van Hooft
- Emo E van Halsema, Jeanin E van Hooft, Department of Gastroenterology and Hepatology, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
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Zander T, Medina S, Montes G, Nuñez-Atahualpa L, Valdes M, Maynar M. Endoluminal occlusion devices: technology update. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:425-36. [PMID: 25489252 PMCID: PMC4257107 DOI: 10.2147/mder.s49540] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Endoluminal occlusion has been performed since the early beginning of interventional radiology. Over recent decades, major technological advances have improved the techniques used and different devices have been developed for changing conditions. Most of these occlusion devices have been implemented in the vascular territory. Early embolization materials included glass particles, hot contrast, paraffin, fibrin, and tissue fragments such as muscle fibers and blood clots; today, occlusion materials include metallic devices, particles, and liquid materials, which can be indicated for proximal or distal occlusion, high-flow and low-flow situations, and in large-caliber and small-caliber vessels, based on need. Technological progress has led to a decreased size of delivery catheters, and an increase in safety due to release systems that permit the withdrawing and replacement of embolization material. Furthermore, bioactive embolization materials have been developed to increase the efficacy of embolization or the biological effect of medication. Finally, materials have been modified for changing indications. Intravascular stents were initially developed to keep an artery open; however, by adding a covering membrane, these stents can be used to occlude the wall of a vessel or other endoluminal structures. This article gives an overview of the devices most utilized for occlusion of endoluminal structures, as well as their major purpose in the endovascular territory.
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Affiliation(s)
- Tobias Zander
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain
| | - Samantha Medina
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain
| | - Guillermo Montes
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain
| | | | - Michel Valdes
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain
| | - Manuel Maynar
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain ; University of Las Palmas de Gran Canarias, Las Palmas, Canary Island, Spain
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