Biodegradable oesophageal stents for refractory benign disease: a case series

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Gut

2011;60:A174-A175

doi:10.1136/gut.2011.239301.371

Posters

Oesophagus

Biodegradable oesophageal stents for refractory

benign disease: a case series

S Hazeldine *1,

J Wu1,

R Law2,

R Przemioslo1- Author Affiliations

1Gastroenterology, Frenchay Hospital, Bristol, UK

2Frenchay Hospital, Bristol, UK

Abstract

Introduction

Benign oesophageal strictures that are refractory to dilatation are

difficult to treat and may require the placement of an

oesophageal stent. Biodegradable

oesophageal stents (BDOS) are licensed for use in benign oesophageal

strictures including

achalasia. The biodegradable stent

has advantages over metal stents as it negates the need for removal and

has few reported

local adverse events, the most

common being stent migration. We report our experience of BDOS in

patients with benign oesophageal

strictures refractory to repeated

dilatation.

Methods

Patients were considered to have refractory benign oesophageal

strictures if histology was negative for malignancy and had

undergone at least 3 previous

balloon dilatation procedures. Ella BD Polydioxanone stents (UK Medical)

were placed under endoscopic

and fluoroscopic visualisation with

conscious sedation. Stent position and function was checked the

following day with a barium

swallow. Patients were then followed

up clinically, recording dysphagia symptoms, stent migration and

complications.

Results

Four patients were identified with refractory benign oesophageal

strictures. Mean age 68 (57–87), 3 male and 1 female. Stricture

aetiology; 2 achalasia, 1 peptic and 1 postradiotherapy. Follow-up

period poststent insertion ranged from 1 to 7 months. On initial

inspection all 4 stents were placed correctly. Follow-up barium swallow

on day 1 showed one stent had migrated distally (achalasia), this was

replaced in the correct position endoscopically. At day 7, dysphagia was

not relieved in 1 of 4 patients (achalasia), despite adequate stent

patency. At 1 month only 1 of 4 patients had symptom relief (peptic

stricture) and was still symptom free at 7 months. Complications

included severe odynophagia requiring stent removal (postradiation),

food bolus obstruction and aspiration pneumonia (achalasia).

Conclusion

We have experienced variable success in our use of biodegradable

stents. In our experience BDOS did not provide significant

benefit in those patients with

achalasia especially if it was longstanding and there was poor

oesophageal motility. Only one

patient (peptic stricture) had a

prolonged response to dysphagia. Larger case series are required to

ascertain the role of

BDOS in patients with refractory

benign oesophageal strictures.

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