Management of a refractory benign esophageal stricture with a new biodegradable stent

Palliation of malignant esophageal obstruction and/or esophagorespiratory fistula has been accomplished with both plastic stents (PS) and self-expanding metal stents (SEMS). The role of endoprostheses in the management of benign esophageal strictures has been limited because (1) most benign strictures can be managed with medication or dilation, (2) esophageal stents are generally not removable and most physicians would not accept that restriction for benign disease, and (3) the safety of an indwelling esophageal foreign body for long periods of time is not established. Both PS and SEMS have been utilized for benign esophageal strictures, but to a very limited degree, and primarily in patients who are poor surgical candidates or have a limited life expectancy. 1 Kozarek RA Raltz S Brugge WR et al. Prospective multi-center trial utilizing esophageal Z stent for dysphagia and TE fistulae [abstract]. Gastrointest Endosc. 1995; 41: 353 Google Scholar The delivery system for PS is awkward and the insertion process generally requires esophageal dilation to 15- 18 mm prior to insertion, with an associated risk for perforation of 5% to 8%. 2 Tytgat GNJ Den Hartog Jager FCA Bartelsman JFWM Endoscopic prosthesis for advanced esophageal cancer. Endoscopy. 1986; 18: 32-39 Crossref PubMed Scopus (67) Google Scholar The PS have been prone to migration, especially when an adequate tumor shelf does not exist, as is the case with benign strictures. Noncoated SEMS have had less tendency to migrate due in part to their persistent radial force as well as tumor ingrowth. The more recently developed coated SEMS have thwarted tumor ingrowth but have been limited by a tendency to migrate. 1 Kozarek RA Raltz S Brugge WR et al. Prospective multi-center trial utilizing esophageal Z stent for dysphagia and TE fistulae [abstract]. Gastrointest Endosc. 1995; 41: 353 Google Scholar Both PS and SEMS can be associated with an unpleasant foreign body sensation or even frank retrosternal chest pain, food impaction, and pressure necrosis, therefore making them unappealing for long-term management of benign esophageal strictures. Once SEMS are deployed, endoscopic removal is either very difficult or impossible and may require surgery.