Use of a fully covered self-expandable metal stent for the treatment of benign esophageal diseases

Todd H. Baron, M.D. of the Department of Gastroenterology and Hepatology at Mayo Clinic discusses the use of fully covered stents in the treatment of benign disease of the esophagus for some patients. The covered stents also allow removeability. The study was published in the October 2010 issue of Gastrointestinal Endoscopy.

ABSTRACT
Background
Fully covered self-expandable metal stents (FCSEMSs) have been proposed for the treatment of benign esophageal diseases.

Objective
To review our experience with FCSEMSs in patients with benign esophageal diseases.

Design
Retrospective case review of patients who underwent FCSEMS placement for benign esophageal diseases, including:

1. Benign strictures from GERD—caustic and idiopathic causes
2. Radiation-induced strictures
3. Anastomotic strictures
4. Esophageal fistulae/leaks
5. Esophageal perforations

Setting
Tertiary-care medical center. 

Patients
This study involved 37 male and 19 female patients (average age 60 years, range 25-94 years) who underwent FCSEMS placement. 

Intervention
FCSEMS placement.

Main outcome measurements
Technical success with stent placement and removal, stent migration, long-term and short-term complications, and treatment success according to clinical symptoms, follow-up endoscopy, or imaging.

Results
Stent placement was successful in 100 of 107 (93%) procedures, with a total of 104 stents placed. Migration was noted in 37 of 104 (35.6%) stents and was seen more frequently with proximal stents and stents placed for anastomotic strictures. Initial treatment success was seen in 56% of patients with any stricture and in 38% of patients with a fistula/leak or perforation, although data to document long-term resolution were lacking. 

Limitations
This was a retrospective review with patients selected from a tertiary-care medical center. Two endoscopists performed the majority of procedures. 

Conclusion
Temporary placement of FCSEMSs for benign esophageal diseases has moderate clinical efficacy and is limited by stent migration. Removability was easily demonstrated. Newer developments in stent design may improve clinical outcomes for these patients.

J. C. Bakken, M.D., Louis M. Wong Kee Song, M.D.,  Piet C. de Groen, M.D., Todd H. Baron, M.D.