Self-Expanding Stents in Benign Esophageal Strictures

Abstract

Self-expanding metal stents (SEMS) have gained a wide consensus in the treatment of malignant dysphagia. The small diameter of the delivery system has reduced the morbidity related to their placement. These stents could be a reasonable option also in patients with benign refractory esophageal strictures. Two types of stents have been used: self-expandable plastic stent (SEPS; Polyflex ® ) and SEMS. Fluoroscopy is recommended, and predeployment dilation should be performed when a SEPS is placed. SEMS should be completely covered with a silicone layer that opposes the granulomatous ingrowth through the meshes, which prevents imbedding and allows easy retrieval. Migration represents the most frequent complication and is due to the lack of imbedding of these stents. The techniques of stent placement are similar to those when stents are placed for malignant disease. Dilation is not advisable before placing a SEMS, but may be performed after its release. The prolonged and stable dilation of the endoprosthesis is believed to work in some patients by prevention of the scarring process and avoiding the adhesion of damaged areas (such as after extensive endoscopic mucosal resection). Remodeling of scar tissue by the indwelling stent is believed to occur in chronic strictures but is difficult to obtain in patients with refractory hypopharyngeal strictures following radiation therapy. Stents need to be removed, the timing of which is variable but usually more than 4 to 8 weeks after placement. Prolonged placement may lead to complications such as reactive overgrowth and result in a new stricture. This review analyses the risk and benefits of self-expandable stents in the management of dysphagia for benign esophageal strictures.