Stents for benign esophageal strictures

Abstract

Management strategies for benign esophageal strictures aim to restore luminal patency and resolve dysphagia symptoms. Multiple therapeutic options are available, including temporary esophageal stent placement. Placement of a temporary esophageal stent may be advantageous over other strategies for their continuous expansion of the stricture, leading to stricture remodeling. After temporary stent placement, 40% of patients have a complete resolution of dysphagia requiring no additional therapy. However, this should be traded-off against a relatively high risk of adverse events. It is therefore that current clinical guidelines advise the use of temporary esophageal stent placement in patients who failed previous endoscopic dilation strategies. When temporary esophageal stent placement is considered, fully covered self-expanding metallic stent should preferably be used and stent should be removed no later than 3 months after initial placement. The full covering of this stent type prevents hyperplastic tissue ingrowth. However, stent migration is not uncommon, occurring in 32% of patients. Ongoing studies aim to improve stent designs and reduce stent-related adverse events. Especially biodegradable stents are becoming a promising alternative to fully covered self-expanding metallic stent as their gradual disintegration makes subsequent stent removal unnecessary. In addition, increasing evidence shows that outcomes of temporary stent placement differ based on stricture etiology, which might affect timing of stent placement and selection of the best approach in individual patients.