Table 1.
Literature on self-expandable stent placement for refractory benign esophageal strictures
| Ref. | Study design | Patients, indications | Stent type, technical success rate, scheduled removal | Follow-up median (range) | Complications | Successful stent removal | Clinical success (dysphagia-free) |
| Prospective cohort studies including patients with RBES according to Kochman’s criteria | |||||||
| Chaput et al[9] 2013 | Prospect | Patients with recurrent benign strictures after more than 3 dilatations to more than 15 mm during the previous 12 mo: n = 41 1 Anastomotic stricture: 29% (12/41) 2 Peptic stricture: 39% (16/41) 3 Caustic stricture: 7% (3/41) 4 Radiation stricture: 20% (8/41) 5 Others: 5% (2/41) | Standard FC SEMS: 100% (24/24) - 4 wk Multilayer silicone FC SEMS: 100% (17/17) - 3 mo | 24 mo | Overall complications: Stent migration: 29.3% (12/41) Chest pain requiring stent removal or repositioning: 9.8% (4/41) Chest pain resolved with conservative management: 2.4% (1/41) Vomiting: 2.4% (1/41) Pneumonia: 2.4% (1/41) | FC SEMS: 100% (41/41) | Overall clinical success: 9.8% (4/41) |
| Canena et al[10] 2012 | Prospect | Patients with RBES according to Kochman criteria: n = 30 1 Anastomotic stricture: 43% (13/30) 2 Peptic stricture: 23% (7/30) 3 Caustic stricture: 10% (3/10) 4 Radiation stricture: 7% (2/30) 5 Idiopathic stricture: 17% (5/30) | BD stent: 100% (10/10) SEPS: 100% (10/10) - 12 wk FC SEMS: 100% (10/10) - 12 wk | 23.4 (8-66) mo | Patients with complications (P = 0.38): BD stent 50%, SEPS 70%, FC SEMS 60% Stent migration (P = 0.16): BD stent 20%, SEPS 60%, FC SEMS 30% Tissue hyperplasia (P = 0.09): BD stent 30%, SEPS 0%, FC SEMS 0% Associated with one major bleeding and recurrent dysphagia in two patients Minor complications in 17% (5/30) of patients: 1 Globus sensation: BD stent 0%, SEPS 0%, FC SEMS 10% 2 Moderate chest pain: BD stent 0%, SEPS 20%, FC SEMS 10% 3 Reflux: BD stent 0%, SEPS 10%, FC SEMS 10% Major complications in 7% (2/30) of patients: 1 Major bleeding: BD stent 10%, SEPS 0%, FC SEMS 0% 2 Severe chest pain: BD stent 10%, SEPS 0%, FC SEMS 0% | SEPS: 100% (10/10) FC SEMS: 100% (10/10) | Overall: 27% (8/30) Stent type (P = 0.27): 1 BD stent: 30% (3/10) 2 SEPS: 10% (1/10) 3 FC SEMS: 40% (4/10) |
| Hirdes et al[11] 2012 | Prospect | Patients with RBES according to Kochman criteria: n = 28 1 Peptic stricture: 32% (9/28) 2 Anastomotic stricture: 25% (7/28) 3 Radiation stricture: 11% (3/28) 4 Caustic stricture: 7% (2/28) 5 Others: 11% (3/28) 6 Unknown origin: 14% (4/28) | Single BD stent: n = 15 Sequential BD stent: n = 13 Technical success: 100% (28/28) In total 59 BD stent placed | 630 (21-1121) d | Stent migration: 10.7% (3/28) Food impaction: 10.7% (3/28) Major complications of 59 stent placements in 28 patients: 29% (8/28) of patients 1 Retrosternal pain and vomiting: 7.1% (2/28) 2 Retrosternal pain: 7.1% (2/28) 3 Bleeding: 7.1% (2/28) 4 Fever and vomiting: 3.6% (1/28) 5 Aspiration pneumonia: 3.6% (1/28) Minor complications of 59 stent placements in 28 patients: 14% (4/28) of patients 1 Retrosternal pain: 7.1% (2/28) 2 Reflux: 3.6% (1/28) 3 Vomiting: 3.6% (1/28) One patient (3.6%) died of aspiration pneumonia, relation to stent unclear | Not applicable | At 6 mo after: First stent: 25% (7/28) Second stent: 15% (2/13) Third stent: 0% (0/7) |
| Hirdes et al[12] 2012 | Prospect | Patients with RBES according to Kochman criteria: n = 15 1 Peptic stricture: 40% (6/15) 2 Caustic stricture: 20% (3/15) 3 Radiation stricture: 13% (2/15) 4 Other: 7% (1/15) 5 Unknown cause: 20% (3/15) | FC SEMS: 100% (15/15) 109 d (87-222) | After stent removal: 86 (14-330) d | Stent migration: 33% (5/15) Tissue overgrowth: 20% (3/15) Major complications in 20% (3/15) of patients: 1 Severe pain requiring stent removal: 7% (1/15) 2 Severe persistent odynophagia: 7% (1/15) 3 Nausea/vomiting: 13% (2/15) 4 Aspiration pneumonia: 7% (1/15) Minor complications: 1 Pain: 20% (3/15) | 93% (14/15) Stent-in-stent: 7% | 0% (0/15) |
| Eloubeidi et al[13] 2011 | Pro- and retrospect | Patients with benign esophageal lesions treated with Alimaxx-E stent: n = 35 Leaks/fistulae: n = 12 Perforations: n = 4 RBES: n = 19 1 Anastomotic stricture: 37% (7/19) 2 Peptic stricture: 21% (4/19) 3 Caustic stricture: 11% (2/19) 4 Radiation stricture: 11% (2/19) 5 Others: 21% (4/19) | FC SEMS: 100% (19/19) In situ for: 64 ± 74 d (range 6-300) | 161 ± 111 (range 24-360) d | Stent migration: 36.8% (7/19) Minor complications in patients with RBES: 1 Stent infolding/invagination: 16% (3/19) 2 Chest pain: 5% (1/19) 3 Abdominal pain: 11% (2/19) 4 Globus sensation: 5% (1/19) 5 Fever: 5% (1/19) Major complications in patients with RBES: 1 Arrhythmia: 5% (1/19) | 97% (34/35) Stent fracture: 3% | 21% (4/19) |
| Van Boeckel et al[14] 2011 | Prospect | Patients with RBES according to Kochman criteria: n = 38 1 Anastomotic stricture: 34% (13/38) 2 Peptic stricture: 18% (7/38) 3 Radiation stricture: 18% (7/38) 4 Caustic stricture: 16% (6/38) 5 Others: 11% (4/38) 6 Unknown etiology: 3% (1/38) | BD stent: 100% (18/18) SEPS: 95% (19/20) - 6 wk | BD stent: 166 (21-559) d SEPS: 385 (77-924) d | Major complications: 15.8% (6/38) 1 Hemorrhage: SEPS 5%, BD stent 11% 2 Perforation: SEPS 5%, BD stent 0% 3 Severe pain requiring opiates: SEPS 0%, BD stent 11% Minor complications: 10.5% (4/38) 1 Reflux: SEPS 0%, BD stent 6% 2 Nausea/vomiting: SEPS 5%, BD stent 11% Stent migration: SEPS 25% (5/20), BD stent 22% (4/18) Food impaction: SEPS 0%, BD stent 11% (2/18) Tissue in-/overgrowth: SEPS 0%, BD stent 11% (2/18) A FC SEMS was placed in both patients | SEPS: 100% (16/16) | Stent type (P = 0.83): 1 SEPS: 30% (6/20) 2 BD stent: 33% (6/18) |
| Repici et al[15] 2010 | Prospect | Patients with RBES according to Kochman criteria: n = 21 1 Peptic stricture: 33% (7/21) 2 Anastomotic stricture: 24% (5/21) 3 Radiation stricture: 24% (5/21) 4 Caustic stricture: 10% (2/21) 5 Other: 5% (1/21) 6 Idiopathic stricture: 5% (1/21) | BD stent: 100% (21/21) | 53 (25-88) wk | Stent migration: 9.5% (2/21) Severe thoracic pain requiring analgesics: 14.3% (3/21) Minor bleeding: 4.8% (1/21) Dysphagia caused by hyperplastic tissue: 4.8% (1/21) | Not applicable | 45% (9/20) |
| Dua et al[16] 2008 | Prospect | Patients with RBES according to Kochman criteria: n = 40 1 Anastomotic stricture: 30% (12/40) 2 Caustic stricture: 20% (8/40) 3 Radiation stricture: 18% (7/40) 4 Peptic stricture: 5% (2/40) 5 Others: 28% (11/40) | SEPS: 95% (38/40) 4 wk | 53 (11-156) wk | Stent migration: 22.2% (8/36) Severe chest pain requiring medication: 11.1% (4/36) Fistula: 2.8% (1/36) Perforation: 5.6% (2/36) Gastroesophageal reflux: 5.6% (2/36) Bleeding: 8.3% (3/36) Stent-related mortality: 2.8% (1/36) Massive bleeding probably due to stent eroding into major vessel | 94% (31/33) Inability to remove stent: 6% (2/33) | 30% (12/40) |
| Remaining prospective cohort studies | |||||||
| Van Hooft et al[17] 2011 | Prospect | Patients with an esophagogastric anastomotic stricture who did not have had any endoscopic treatment: n = 10 | BD stent: 100% (10/10) | 6 mo | Food impaction: 10% (1/10) Hyperplasia-induced obstruction: 20% (2/10) | Not applicable | 60% (6/10) |
| Evrard et al[18] 2004 | Prospect | SEMS-induced stricture: n = 5 Esophagocolonic anastomotic stricture: n = 4 Refractory benign strictures after a median of 6 (range 1-12) dilation sessions per year: n = 8 Anastomotic leak: n = 4 | SEPS: 100% (21/21) Range 2 d–18 mo | After stent removal: 21 (8-39) mo | Stent migration: 57.1% (12/21) Stridor due to tracheal compression: 4.8% (1/21) Inflammatory epiglottic stenosis: 4.8% (1/21) | 100% (21/21) | 76% (13/17) |
| Repici et al[19] 2004 | Prospect | Patients with persisting benign esophageal strictures after at least 6 dilation sessions: n = 15 1 Caustic stricture: 33% 2 Anastomotic stricture: 27% 3 Radiation stricture: 27% | SEPS: 100% (15/15) 6 wk | Mean: 22.7 (19-27) mo | Severe chest pain requiring analgesics: 33% (5/15) Mild/moderate mucosal hyperproliferation: 27% (4/15) Stent migration: 7% (1/15) | 100% (15/15) | 80% (12/15) |
RBES: Refractory benign esophageal strictures; SEPS: Self-expandable plastic stent; BD stent: Biodegradable stent; FC SEMS: Fully covered self-expandable metal stent.