Self-Expandable Plastic Stent (SEMS) for Treatment of Benign and Malignant Strictures of the Esophagus and Colon

Abstract

Purpose: SEPS are designed to be removed making them suitable for treatment of benign refractory strictures and for early palliation of malignant strictures awaiting response to chemoradiation. We present our experience with SEPS in benign and malignant strictures of the esophagus and colon. Methods: A retrospective database search between July 2004 and February 2006 to identify patients with SEPS placement was conducted. Demographics, nature and location of stricture, dilation history, outcomes and complications were recorded. Results: A total of 29 SEPS were placed in 18 patients: 8 with malignant strictures and 10 with benign esophageal strictures. In malignant stricture (MS) group were 5 primary esophageal, 1 lung, and 2 rectosigmoid cancers. In benign esophageal stricture (BS) group were 3 anastomotic, 1 post chemoradiation, 3 post photodynamic therapy (PDT), and 3 post inflammatory strictures. Median stricture length was 5 cm. Median dilations prior to SEPS for BS were 6 (2–16). SEPS placement was successful in all. Dilation prior to SEPS placement was required in 16 patients. Immediate relief of dysphagia occurred in 14 patients. In the BS group, stents were removed no later than 8 weeks. Stent migration occurred in 8 patients (3 in the MS group) in a median of 22 days. Two patients required narcotic analgesics immediately post stent placement. Two patients with benign stricture developed tracheoesophageal fistula at the middle of stent after the multiple stent exchange. In BS group, restenosis occurred within a median of 26 days (range 6–286 days). The median days to restenosis was 127 days if the stent was retained more than 42 days. In MS group, all patients had successful palliation of stricture. One patient with esophageal cancer is undergoing chemoradiation with SEPS for 306 days while maintaining oral intake. Two patients with colonic SEPS have had good palliation; one till death at 59 days and the other still living at 173 days post placement. Conclusions: We observed a stent migration rate of 44% in our population and 12% developed tracheoesophageal fistula. Long term success in BS group was limited; time to restenosis of benign strictures seemed to lengthen with retention of the SEPS for greater than 42 days. More study is needed to define the ideal candidate for SEPS placement in those patients with refractory benign stricture.