Abstract
We agree that the covered self-expanding metal stents (SEMSs) fare better than the uncovered stents as recurrent dysphagia due to tumor ingrowth is common with uncovered stent. Recent American College of Gastroenterology Practice Guideline on the Role of Esophageal Stents in Benign and Malignant Diseases concludes that SEMSs cannot be routinely recommended in conjunction with chemo-radiation. The comparison of ultraflex and choostent in the Italian study found no difference in the palliation of dysphagia, rate of complications and survival rate.
Keywords: Self-expanding metallic esophageal stents, Dysphagia, Esophageal stents
TO THE EDITOR
We read with interest the article “Covered nitinol stents for the treatment of esophageal stricture and leaks” by Bona et al[1] in the May 14, 2010 issue of World Journal of Gastroenterology. We agree that covered self-expanding metal stents (SEMSs) fare better than uncovered stents as recurrent dysphagia due to tumor ingrowth is common with uncovered stent[2]. Partially covered SEMSs are superior to uncovered SEMSs in the palliation of dysphagia due to unresectable esophageal tumor[3].
Although the study discussed the positive role of temporary stent placement in patients undergoing neoadjuvant therapy, recent American College of Gastroenterology Practice Guideline on the Role of Esophageal Stents in Benign and Malignant Disease concludes that SEMSs cannot be routinely recommended in conjunction with chemo-radiation[4]. The data on use of SEMSs for gastroesophageal junction cancers with concomitant radiation are retrospective, discordant and limited[5,6].
The self-expanding plastic stents are preferable over SEMSs as temporary stent insertion in case of anastomotic complications or post-radiotherapeutic stricture because the option of retrieval is better, there is limited local tissue reaction and is of lower costs[7].
SEMSs are useful in patients with poor functional status who cannot tolerate chemotherapy or radiotherapy, who have advanced metastatic disease or in whom previous therapy has failed[8]. This data was lacking in the study, and it would have given a better way to compare ultraflex and choostent.
Bona et al[9] in their study of comparison of ultraflex and choostent found no difference in the palliation of dysphagia, rate of complications and survival rates. Both stents were safely removable in short term follow-up. The benefit of temporary insertion of both types of stents was documented in patients with esophageal carcinoma prior to chemotherapy or chemoradiotherapy and in those with anastomotic strictures or leaks. The ideal timing for metallic stent removal is not well defined and varies from 2 wk to 4 mo. However, it is safe to remove within 2 mo after stent placement[10].
So, further studies are required before firm recommendation regarding the choostent can be made.
Footnotes
Peer reviewer: Dr. Josep M Bordas, MD, Department of Gastroenterology IMD, Hospital Clinic, Llusanes 11-13, Barcelona 08022, Spain
S- Editor Wu X L- Editor Ma JY E- Editor Xiong L
References
- 1.Bona D, Laface L, Bonavina L, Abate E, Schaffer M, Ugenti I, Siboni S, Carrinola R. Covered nitinol stents for the treatment of esophageal strictures and leaks. World J Gastroenterol. 2010;16:2260–2264. doi: 10.3748/wjg.v16.i18.2260. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Vakil N, Morris AI, Marcon N, Segalin A, Peracchia A, Bethge N, Zuccaro G, Bosco JJ, Jones WF. A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction. Am J Gastroenterol. 2001;96:1791–1796. doi: 10.1111/j.1572-0241.2001.03923.x. [DOI] [PubMed] [Google Scholar]
- 3.Saranovic Dj, Djuric-Stefanovic A, Ivanovic A, Masulovic D, Pesko P. Fluoroscopically guided insertion of self-expandable metal esophageal stents for palliative treatment of patients with malignant stenosis of esophagus and cardia: comparison of uncovered and covered stent types. Dis Esophagus. 2005;18:230–238. doi: 10.1111/j.1442-2050.2005.00484.x. [DOI] [PubMed] [Google Scholar]
- 4.Sharma P, Kozarek R. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol. 2010;105:258–273; quiz 274. doi: 10.1038/ajg.2009.684. [DOI] [PubMed] [Google Scholar]
- 5.Homs MY, Hansen BE, van Blankenstein N. Prior radiation and /or chemotherapy has no effect on the outcome of metal stent placement for oesophagastric carcinoma. Eur J gastroenterol Hepatol. 2004;16:163–170. doi: 10.1097/00042737-200402000-00007. [DOI] [PubMed] [Google Scholar]
- 6.Lecleire S, Di Fiore F, Ben-Soussan E, Antonietti M, Hellot MF, Paillot B, Lerebours E, Ducrotté P, Michel P. Prior chemoradiotherapy is associated with a higher life-threatening complication rate after palliative insertion of metal stents in patients with oesophageal cancer. Aliment Pharmacol Ther. 2006;23:1693–1702. doi: 10.1111/j.1365-2036.2006.02946.x. [DOI] [PubMed] [Google Scholar]
- 7.Holm AN, de la Mora Levy JG, Gostout CJ, Topazian MD, Baron TH. Self-expanding plastic stents in treatment of benign esophageal conditions. Gastrointest Endosc. 2008;67:20–25. doi: 10.1016/j.gie.2007.04.031. [DOI] [PubMed] [Google Scholar]
- 8.Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med. 2001;344:1681–1687. doi: 10.1056/NEJM200105313442206. [DOI] [PubMed] [Google Scholar]
- 9.Bona D, Laface L, Siboni S, Schaffer M, Baldoli D, Sironi A, Sorba F, Bonavina L. [Self-expanding oesophageal stents: comparison of Ultraflex and Choostent] Chir Ital. 2009;61:641–646. [PubMed] [Google Scholar]
- 10.Peters JH, Craanen ME, van der Peet DL, Cuesta MA, Mulder CJ. Self-expanding metal stents for the treatment of intrathoracic esophageal anastomotic leaks following esophagectomy. Am J Gastroenterol. 2006;101:1393–1395. doi: 10.1111/j.1572-0241.2006.00615.x. [DOI] [PubMed] [Google Scholar]