Use of a Self-Expanding, Removable, Plastic Stent (Polyflex®) for Esophageal Fistulae, Perforations and Benign and Malignant Strictures: Early Experience At a Single Institution

Abstract

Use of a Self-Expanding, Removable, Plastic Stent (Polyflex ) for Esophageal Fistulae, Perforations and Benign and Malignant Strictures: Early Experience At a Single Institution Drew Schembre, Richard Kozarek Background: Traditionally, esophageal perforations, fistulae and recalcitrant strictures required surgical correction or placement of a permanent stent. A selfexpanding, plastic stent designed to be removed, (Polyflex Boston Scientific Inc., Boston), recently became available. We review our initial experience with the stent in a variety of esophageal situations. Methods: We reviewed all patients who received a Polyflex stent for an esophageal indication at our institution between 1/2004 and 11/2005. Indication for treatment, location, duration of placement, rate of migration and time to migration, complications and efficacy were recorded. Results: A total of 20 stents were successfully placed in 16 patients. 4 were placed for fistulae, 2 for perforations, 5 for malignant strictures, and 9 for benign strictures (6 anastamotic, 2 radiation and 1 caustic). Median follow-up was 12 months. 10 were placed in the proximal esophagus, 4 in the middle and 6 at the EG junction. 14 stents were eventually removed and 6 remained in place (3 for malignancy 3 anticipating removal). 4 stents migrated spontaneously (1 distally and 3 proximally). The median time in place was 4 weeks with a mean time to migration of 10 days. All stents that were removed, including migrated stents, came out easily with ‘‘rat’s tooth’’ forceps and slow, constant traction. None of the fistulae or perforations healed with stent placement. One fistula enlarged and one malignant stricture fistulized after stent removal. 8 stent placements resulted in at least temporary pain requiring narcotic analgesia. No deaths or other major complications occurred as a result of stent placement or removal. Of the 8 benign strictures in which the stent has been removed, 4 (50%) have experienced improvement of their dysphagia for at least 1 month. One patient who had 2 Polyflex stents placed for a caustic stricture has refused to return for stent removal, even after 12 months. Conclusion: Polyflex stents are easily placed and removed from the esophagus. Stent migration occurs occasionally, and may not occur for several days. Resolution of perforations and fistulae has been disappointing, but temporary stent placement can provide at least temporary relief of dysphagia from benign strictures.