Management of a refractory benign esophageal stricture with a new biodegradable stent

Abstract

Palliation of malignant esophageal obstruction and/or esophagorespiratory fistula has been accompushed with both plastic stents (PS) and self-expanding metal stents (SEMS). The role of endoprostheses in the management of benign esophageal strictures has been limited because (1) most benign strictures can be managed with medication or dilation, (2) esophageal stents are generally not removable and most physicians would not accept that restriction for benign disease, and (3) the safety of an indwelling esophageal foreign body for long periods of time is not established. Both PS and SEMS have been utilized for benign esophageal strictures, but to a very limited degree, and primarily in patients who are poor surgical candidates or have a limited life expectancy. 1 The delivery system for PS is awkward and the insertion process generally requires esophageal dilation of 15 to 18 mm prior to insertion, with an associated risk for perforation of 5% to 8%. 2 The PS have been prone to migration, especially when an adequate tumor shelf does not exist, as is the case with benign strictures. Noncoated SEMS have had less tendency to migrate due in part to their persistent radial force as well as tumor ingrowth. The more recently developed coated SEMS have thwarted tumor ingrowth but have been limited by a tendency to migrate. 1 Both PS and SEMS can be associated with an unpleasant foreign body sensation or even frank retrosternal chest pain, food impaction, and pressure necrosis, therefore making them unappealing for long-term management of benign esophageal strictures. Once SEMS are deployed, endoscopic removal is either very difficult or impossible and may require surgery. Temporary placement of plastic biliary stents for benign biliary strictures has been successful in some instances, allowing for the eventual removal after remodeling of the fibrotic stenoses. 3 Applying this con