Abstract
Background
Esophageal stenting has become an important technique in the treatment of different clincal problems such as malignant or benign stenosis, anastomotic leaks after surgery, or fistulas. In this study we present our experience with the self-expanding Polyflex plastic stent in various indications, arising complications, and patient’s outcomes.
Methods
Over a three-year period, 35 patients underwent self-expanding Polyflex plastic stent placement for esophageal stenosis (n = 23) with 22 malignant, and for perforations, fistulas, or anastomotic leaks after surgery (n = 12). The short-term efficacy and long-term outcomes were analyzed.
Results
In patients with stenosis, implantation was performed without any complications in 91% (21/23). In one patient perforation occurred while passing the stenosis; in another patient the stent dislocated during the insertion procedure. Dysphagia score improved from 3.0 to 1.0 after stenting. In all patients with perforations, fistulas, or anastomotic leaks (n = 12), stents were placed successfully without any complication. Complete sealing of the mucosal defect was proven by radiography in 92% (n = 11) and healing was seen in 42% (n = 5). If indicated, stent removal was performed without any complications. Stent migration (n = 13; 37%) was the most common long-term complication.
Conclusions
The placement of self-expanding Polyflex plastic stents is a highly sufficient and cost-effective treatment for malignant and benign esophageal disorders. Because the long-term results were highly favorable, self-expanding plastic stent placement could be used as the initial treatment for various conditions.
Similar content being viewed by others
References
Adam A, Ellul J, Watkinson A (1997) Palliation of inoperable esophageal carcinoma: a prospective randomized trial of laser therapy and stent placement. Radiology 202: 344–348
Bethge N, Nimish V (2001) A prospective trial of a new self-expanding plastic stent for malignant esophageal obstruction. Am J Gastroenterol 96: 1350–1354
Decker P, Lippler J, Decker D, Hirner A (2001) Use of the Polyflex stent in the palliative therapy of esophageal carcinoma. Surg Endosc 15: 1444–1447
Dormann AJ, Eisendrath P, Wigginghaus B, Huchzermeyer H, Deviere J (2003) Palliation of esophageal carcinoma with a new self-expanding plastic stent. Endoscopy 35: 207–211
Evrard S, Le Moine O, Lazaraki G, Dormann A, El Nakadi I, Deviere J (2004) Self-expanding plastic stents for benign esophageal lesions. Gastrointest Endosc 60: 894–900
Gelbmann CM, Ratiu NL, Rath HC, Rogler G, Lock G, Schölmerich J, Kullmann F (2004) Use of self-expandable plastic stents for the treatment of esophageal perforations and symptomatic anastomotic leaks. Endoscopy 36: 695–699
Gevers AM, Macken E, Hiele M, Rutgeerts P (1998) A comparison of laser therapy, plastic stents, and expandable metal stents for palliation of malignant dysphagia in patients without a fistula. Gastrointest Endosc 48: 383–388
Hühnerbein M, Stroszczynski C, Moesta KT, Schlag PM (2004) Treatment of thoracic anastomotic leaks after esophagectomy with self-expanding plastic stents. Ann Surg 240: 801–807
Kennedy C, Steger A (2001) Fatal hemorrhage in stented esophageal carcinoma: tumor necrosis of the aorta. Cardiovasc Intervent Radiol 24: 443–444
Langer FB, Wenzl E, Prager G, Salat A, Miholic J, Mang T, Zacherl J (2005) Management of postoperative esophageal leaks with the polyflex self-expanding covered plastic stent. Ann Thorac Surg 79: 398–404
Lee SH (2001) The role of oesophageal stenting in the non-surgical management of oesophageal strictures. Br J Radiol 74: 891–900
Mayoral W, Fleischer D, Salcedo J, Roy P, Al-Kawas F, Benjamin S (2000) Nonmalignant obstruction is a common problem with metal stents in the treatment of esophageal cancer. Gastrointest Endosc 51: 556–559
Mosca F, Stracqualursi A, Portale TR, Consoli A, Latteri S (2000) Palliative treatment of malignant esophageal stenosis: the role of self-expanding stent endoscopic implantation. Dis Esophagus 13: 301–304
Mosca R, Consoli A, Stracqualursi A, Persi A, Portale TR (2003) Comparative retrospective study on the use of plastic prostheses and self-expanding metal stents in the palliative treatment of malignant strictures of the esophagus and cardia. Dis Esophagus 16: 119–125
Muto M, Ohtsu A, Miyata Y, Shioyama Y, Boku N, Yoshida S (2001) Self-expandable metallic stents for patients with recurrent esophageal carcinoma after failure of primary chemoradiotherapy. J Clin Oncol 31: 270–274
O’Donnell CA, Fullarton GM, Watt E, Lennon D, Murray D, Moss JG (2002) Randomized clinical trial comparing self-expanding metallic stents with plastic endoprotheses in the palliation of oesophageal cancer. Br J Surg 89: 985–992
Radecke K, Gerken G, Treichel U (2005) Impact of a self-expanding, plastic esophageal stent on various esophageal stenoses, fistulas, and leakages: a single-center experience in 39 patients. Gastrointest Endosc 61: 812–818
Sabharwal T, Hamady MS, Chui S, Atkinson S, Mason R, Adam A (2003) A randomised prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma. Gut 52: 922–926
Sarper A, Oz N, Cihangir C, Demircan A, Isin E (2003) The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas. Eur J Cardiothorac Surg 23: 794–798
Shin JH, Song HY, Ko GY, Lim JO, Yoon HK, Sung KB (2004) Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology 232: 252–259
Sihvoe EI, Pentikainen T, Luostarinen ME, Ramo OJ, Salo JA (2002) Inoperable adenocarcinoma of the oesophagogastric junction: a comparative clinical study of laser coagulation versus self-expanding metallic stents with special reference to cost analysis. Eur J Surg Oncol 28: 711–715
Szentpali K, Palotas A, Lazar G, Paszt A, Balogh A (2004) Endoscopic intubation with conventional plastic stents: a safe and cost-effective palliation for inoperable esophageal cancer. Dysphagia 19: 22–27
Therasse E, Oliva VL, Lafontaine E, Perreault P, Giroux MF, Soulez G (2003) Balloon dilatation and stent placement for esophageal lesions: indications, methods, and results. Radiographics 23: 89–105
Tomaselli F, Maier A, Sankin O, Pinter H, Smolle J, Smolle-Juttner FM (2004) Ultraflex stent—benefits and risks in ultimate palliation of advanced, malignant stenosis in the esophagus. Hepatogastroenterology 51: 1021–1026
Wang MQ, Sze DY, Wang ZP, Wang ZQ, Gao YA, Dake MD (2001) Delayed complications after esophageal stent placement for treatment of malignant esophageal obstruction and esophagorespiratory fistulas. J Vasc Interv Radiol 12: 465–474
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ott, C., Ratiu, N., Endlicher, E. et al. Self-expanding Polyflex plastic stents in esophageal disease: various indications, complications, and outcomes. Surg Endosc 21, 889–896 (2007). https://doi.org/10.1007/s00464-006-9067-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-006-9067-x