Self-expanding plastic stents in treatment of benign esophageal conditions

Background: Recently, self-expanding plastic stents (SEPSs) have been proposed for the treatment of benign esophageal disease. Objectives: Our purpose was to review our experience with SEPSs in patients with benign esophageal conditions. Design: This was a retrospective case review of patients who underwent SEPS placement for benign esophageal disease, including (1) benign stricture, including reflux disease, ischemia, and idiopathic, (2) radiation-induced strictures, (3) anastomotic strictures, and (4) esophageal leak/fistulae. Patients: Nineteen male and 11 female patients (average age 52.1 years, range 11-87 years) underwent SEPS placement. Interventions: SEPS placement. Main Outcome Measurements: Initial complications, stent migration, long-term complications, and treatment success according to clinical symptoms, follow-up endoscopy, or imaging. Results: Eighty-three of 84 SEPS placements were successful. The most common complications were chest pain, dysphagia, nausea, and vomiting. No deaths were reported from stent placement. Stent migration was more frequent in proximal (30/44 stents, 68.1%) and distal (19/27 stents, 70.4%) compared with mid esophageal (3/10 stents, 30%). Migration was more frequent in stents placed for benign strictures (18/22 stents, 81.8%), anastomotic strictures (18/24 stents, 75%), and fistulae/leak (13/22 stents, 59.1%) compared with radiation-induced strictures (4/14 stents, 28.6%). Only 5 of 83 interventions (6%) resulted in long-term improvement after stent removal. Limitations: This was a retrospective review, and patients were selected from a tertiary medical center. Conclusion: Use of SEPSs for benign esophageal conditions resulted in frequent stent migration and few cases of long-term improvement. Further investigation is warranted to identify optimal patient populations and to guide future recommendations for the use of SEPSs.