ESOPHAGEAL PLASTIC STENTS (EPS) FOR REFRACTORY BENIGN ESOPHAGEAL STRICTURES (RBES) A NEW APPROACH WITH DISAPPOINTING OUTCOMES

Abstract

Metal stents have poor long-term outcomes for treatment of RBES. Recently, a removable EPS (Polyflex, Boston Scientific, USA) was approved in the US for management of RBES. An EPS is an ideal option for the management of RBES, but data on outcomes of EPS in RBES are lacking. Aim: To study the outcome of EPS in patients with RBES. Patients and Methods: A retrospective review of 3 patients that underwent EPS placement for dysphagia due to RBES that were resistant to conventional dilation therapy. Patient #1: A 56 yo WF with esophageal cancer resected after neo-adjuvant chemoradiation with an anastomotic stricture (diameter 3mm). There was no evidence of residual cancer. She underwent 19 attempts at dilation of the stricture (Savary-6 (maximum dilation 36 Fr), TTS balloon-5 (60 Fr), TTS balloon with triamcinolone injection-4 (54 Fr), needleknife stricturoplasty followed by TTS balloon-4 (54 Fr)). #2: A 37 yo WF with a stricture (6 cm in length, 11 mm in diameter) due to lye ingestion, treated with self-dilations (38 Fr/week) but with some residual dysphagia. #3: A 47 yo WM with laryngeal cancer treated with total laryngectomy and radiation with an anastomotic (3mm) and a radiation stricture (5mm). Patient underwent 2 Maloney dilations (45 Fr) by ENT without resolution of dysphagia. Results: All patients had successful EPS placement for their RBES. Patient 1 had 5 migrations of the EPS treated with endoscopic EPS repositioning and later with placement of a larger EPS that also migrated. Patient 2 developed severe chest pain post EPS placement requiring hospitalization and EPS removal on day 7. Endoscopy revealed severe ulceration and granulation at the proximal phalange of the EPS. Patient 3 developed cellulitis in the neck region on day 6 post EPS placement. Barium swallow revealed a contained perforation at the proximal phalange of the EPS. Endoscopy revealed significant ulceration due to pressure necrosis at the proximal phalange and a contained perforation. All patients required EPS removal and are currently being managed satisfactorily with esophageal self-dilation. Conclusions: EPS are a promising technique to manage RBES. EPS are technically easy to place and remove. However, our initial experience reveals poor outcomes due to adverse events. Improvements in EPS design aimed at preventing stent migration and avoiding ulceration and granulation tissue formation at the proximal phalange may improve outcomes.