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New Generation of Esophageal Stents: Early North American Experience Managing Obstructing Esophageal Cancers, Esophageal Perforations and Tracheoesophageal Fistula

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Koehler, Richard MD1; Ross, Andrew MD2; Gan, Ian MD2; Irani, Shayan MD2; Schembre, Drew MD2; Low, Donald MD1; Kozarek, Richard MD2

American Journal of Gastroenterology: October 2010 - Volume 105 - Issue - p S10
Abstracts: ESOPHAGUS
Free

1. Virginia Mason Medical Center, Division of Thoracic Surgery, Seattle, WA; 2. Virginia Mason Medical Center, Department of Gastroenterology, Seattle, WA.

Purpose: The management of esophageal strictures, perforations and tracheoesophageal fistula(TEF) remains complex, yet improvements in stent technology appear to be increasing the possibility for less invasive, endoscopic treatments using fully covered, metal stents. Self-expanding metal stents (SEMS) can be successfully used for palliation of malignant esophageal obstructions, while fully covered plastic stents are better suited for covering perforations and fistula. The newest generation of SEMS which are fully covered can be used to treat a wide variety of esophageal pathology, allow for coverage of perforations and fistula and are easier to remove than uncovered stents.

Methods: The study reviewed all the patients at our institution in whom a Niti-S (Taewong Medical, Seoul, Korea), or WallFlex (Boston Scientific, Natick, Mass) esophageal stent was placed for stricture, perforation or TEF between March 2009 and December 2009.

Results: A total of 14 stents (11 Niti-S and 3 WallFlex) were placed in 12 patients (7 men and 5 women). Primary indications included 2 malignant strictures, 4 benign strictures, 4 perforations following therapeutic endoscopy, a Boorhave's perforation and a malignant TEF. Mean follow-up was 5 months. Stent deployment was successful in all patients, and removal was successful in the 3 patients attempted. There were no complications from stent placement or removal. Successful coverage or exclusion of the esophageal fistula or perforation was achieved in all 6 patients. Stent migration occured in 3 patients, two with a benign strictures and one with a delayed presentation of Boorhave's perforation. One patient with a malignant stricture developed proximal stenosis requiring dilation 2 months following initial stent placement. All patients in whom a stent was placed for obstruction experienced improvement of their dysphagia, which allowed for resumption of oral diet.

Conclusion: The Niti-S and WallFlex stents are safe, and can be successfully used to treat both benign and malignant esophageal strictures, perforations and fistulas. Although deployment is straight forward, stent migration may be problematic in patients without esophageal stricture or stenosis. The fully covered design of these stents make them well suited for use in perforations and leaks, and their ease of removal make them an option for benign processes. The benefits of radial expansion inherent in the metal body, ability to cover full-thickness esophageal defects, and the ease of removal make these stents extremely versatile as compared to previous generations of esophageal stents.

© The American College of Gastroenterology 2010. All Rights Reserved.