Questions for esophageal stents treatment in acute refractory esophageal variceal bleeding.

Abstract

Potential conflict of interest: Nothing to report. To the Editor: The prospective study by Escorsell et al.1 demonstrated that self‐expandable, covered, esophageal metal stents (SX‐ELLA Danis; Ella‐CS, Hradec Kralove, Czech Republic) have greater efficacy and fewer serious adverse events in controlling acute esophageal variceal bleeding compared with balloon tamponade. If stents would be the primary choice for refractory esophageal variceal bleeding, some questions need to be further clarified. According to reports,2 open esophageal stents located across the esophagogastric junction often have caused gastroesophageal reflux, which is associated with a risk of aspiration. In this research, no gastroesophageal reflux was mentioned. Zehetner et al. also reported stent efficacy for acute bleeding from esophageal varices,5 with the patient's upper body positioned slightly upright to reduce the risk of reflux and aspiration. In clinics, some esophageal stents have been improved with an antireflux design to control stent‐related reflux. Therefore, some questions need to be answered: How many patients in the stent group suffered from gastroesophageal reflux? Did any aspiration occur? How did researchers deal with such issues: by changing the body position or applying some antireflux devices? In the future, more studies will be needed for considering the antireflux issue, including implantation protocol and stent design for controlling acute refractory esophageal variceal bleeding.