The Use of Removable Silicone Stents in Patients with Malignant Esophageal Obstruction: An Initial US Experience

Abstract

Background: The aims of this study are to report a multi-institutional experience with the Polyflex self-expanding silicone stent (Rüsch; Kernen Germany) in patients with malignant stenosis receiving chemoradiation prior to esophagectomy. Methods: A survey was developed to assess procedural success, restoration of oral nutrition, migration, and removal of the Polyflexâ stent. The survey was sent to regional institutions and retrospectively completed for all patients in whom the stent was placed for malignant esophageal obstruction. Results: 12 patients underwent Polyflexâ stent placement. 10 patients had adenocarcinoma and 2 patients had squamous carcinoma. Stent placement was successful in 11/12 patients (92%). The stricture could not be traversed with the delivery catheter in one patient. Restoration of oral nutrition following stent placement occurred in 10/11 patients (91%). Migration of the stent into the stomach occurred in 5 patients (45%) without occurrence of gastric outlet obstruction; there was no proximal migration. In all cases, migration occurred during neoadjuvant therapy and correlated with restoration of an esophageal lumen adequate for oral nutrition. The mean time from stent placement to migration was 23 days. Stents were successfully removed endoscopically or at the time of esophagectomy. Mean duration from stent placement to removal was 49 days. Conclusions: This early experience suggests that the removable silicone Polyflexâ stent is an effective alternative for the management of malignant esophageal stenosis in patients for whom neoadjuvant chemoradiation is planned prior to esophagectomy, and warrants further study. Background: The aims of this study are to report a multi-institutional experience with the Polyflex self-expanding silicone stent (Rüsch; Kernen Germany) in patients with malignant stenosis receiving chemoradiation prior to esophagectomy. Methods: A survey was developed to assess procedural success, restoration of oral nutrition, migration, and removal of the Polyflexâ stent. The survey was sent to regional institutions and retrospectively completed for all patients in whom the stent was placed for malignant esophageal obstruction. Results: 12 patients underwent Polyflexâ stent placement. 10 patients had adenocarcinoma and 2 patients had squamous carcinoma. Stent placement was successful in 11/12 patients (92%). The stricture could not be traversed with the delivery catheter in one patient. Restoration of oral nutrition following stent placement occurred in 10/11 patients (91%). Migration of the stent into the stomach occurred in 5 patients (45%) without occurrence of gastric outlet obstruction; there was no proximal migration. In all cases, migration occurred during neoadjuvant therapy and correlated with restoration of an esophageal lumen adequate for oral nutrition. The mean time from stent placement to migration was 23 days. Stents were successfully removed endoscopically or at the time of esophagectomy. Mean duration from stent placement to removal was 49 days. Conclusions: This early experience suggests that the removable silicone Polyflexâ stent is an effective alternative for the management of malignant esophageal stenosis in patients for whom neoadjuvant chemoradiation is planned prior to esophagectomy, and warrants further study.