Long Term Placement of Self-expanding Plastic Stents is Safe for Benign Esophageal Disease

Abstract

Purpose: Removable self-expanding plastic stents (SEPS) are used for the short-term treatment of benign esophageal diseases including strictures and esophageal fistulae. The purpose of this study was to determine the efficacy and safety of SEPS left in place for greater than 90 days for benign esophageal disease. Methods: Patients receiving a SEPS from 2003-2009 for benign esophageal disease at a single university center were retrospectively identified using an endoscopic database (Provation Medical, Minneapolis, MN). Patients with a stent left in place for more than 90 days were included in this study. Indication for stent placement, stent size, duration of stent placement, follow-up endoscopy and imaging studies, and the efficacy of treatment were collected. Results: Nine patients were included. Indication for stent was benign stricture refractory to dilation (8) or esophageal fistula (1). Cause of the stricture was esophagectomy (7), esophageal Castleman's disease (1). Median age was 53.4 years; 8 were males. SEPS placement was successful in all patients. The median stricture length was 2 cm (range 1-8 cm). Stents were left in place for 3-34 months (median 11). In 7, the stent was removed without difficulty. Six received a second stent for stricture recurrence. The most commonly used stent had a diameter of 18mm. Follow-up EGD was performed in eight patients. One patient had stent placement confirmed after 23 months by a CT scan. Stent migration occurred in 3 patients. The most common endoscopic finding was granulation tissue adjacent to the proximal or distal stent margin. One stent migrated proximally into the proximal esophagus, causing ulceration and stricture requiring dilation. In another patient with proximal stent placement for 27 months, a trachea-esophageal fistula developed after stent removal, requiring placement of a new stent and jejunostomy tube. Conclusion: SEPS can be safely left in place for greater than 3 months in some patients with benign esophageal disease refractory to other treatments. Complications developed in those with proximal esophageal placement. Stent migration was seen in 3/9 (33.3%) of patients.Table