Individually designed fully covered self-expandable metal stents for pediatric refractory benign esophageal strictures

To share our institutional experience of placing individually designed fully covered self-expandable metal stents (FCSEMSs) for the treatment of refractory benign esophageal strictures (RBESs) in pediatric patients. A 10-year retrospective study between May 2009 and July 2020 that includes 14 children with RBESs who were treated with individually designed FCSEMSs. Patients were followed-up regularly after stent placement to observe the improvement of vomiting and dysphagia, changes in stenosis diameter and complications. A total of 20 stents were successfully placed in 14 patients. During a follow-up period ranging from 5 to 83 months, except for one 4-year-old child who could not endure chest pain, the remaining 13 patients all benefited from stenting. Their Ogilvie & Atkinson scores improved from grade III–IV to grade 0-I, and the diameters of the stenosis’ were enlarged from 2–5 mm to 9–14 mm. Two patients developed restenosis and granulation tissue hyperplasia was found in 2 patients and stent migration and malapposition in 2 patients with esophageal perforations that required further endoscopic intervention. The use of FCSEMS for RBES is safe and effective in selected pediatric patients. Rationally designed stents and timely management of postoperative complications are critical to ensure the success of this new method.

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Main recommendations Malignant disease 1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass.Strong recommendation, high quality evidence. 2 ESGE recommends brachytherapy as a valid alternative, alone or in addition to stenting, in esophageal cancer patients with malignant dysphagia and expected longer life expectancy.Strong recommendation, high quality evidence. 3 ESGE recommends esophageal SEMS placement for sealing malignant tracheoesophageal or bronchoesophageal fistulas. Strong recommendation, low quality evidence. 4 ESGE does not recommend SEMS placement as a bridge to surgery or before preoperative chemoradiotherapy because it is associated with a high incidence of adverse events. Other options such as feeding tube placement are preferable. Strong recommendation, low quality evidence. Benign disease 5 ESGE recommends against the use of SEMSs as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and their cost. Strong recommendation, low quality evidence. 6 ESGE suggests consideration of temporary placement of self-expandable stents for refractory benign esophageal strictures. Weak recommendation, moderate quality evidence. 7 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures because of their very low risk of embedment and ease of removability. Weak recommendation, low quality evidence. 8 ESGE recommends the stent-in-stent technique to remove partially covered SEMSs that are embedded in the esophageal wall. Strong recommendation, low quality evidence. 9 ESGE recommends that temporary stent placement can be considered for the treatment of leaks, fistulas, and perforations. No specific type of stent can be recommended, and the duration of stenting should be individualized. Strong recommendation, low quality of evidence. 10 ESGE recommends considering placement of a fully covered large-diameter SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive bleeding. Strong recommendation, moderate quality evidence.

FA07.04: THE ROLE OF ENDOSCOPIC DILATION AND STENTS IN THE REFRACTORY BENIGN ESOPHAGEAL STRICTURES: A RETROSPECTIVE ANALYSIS

Background The outcomes of patients with refractory benign esophageal strictures (RBES) was unclear and lacking in relative researches on the clinical efficacy of dilation compared with stent placement. Our objective was to explore the role of endoscopic dilation and stents in the management of RBES. Methods This study including patients with RBES (recurrence of dysphagia despite endoscopic therapy more than 3 sessions) by dilation and stents between January 2009 and December 2017. Endoscopic therapy success was defined as: before the end of the follow-up, no need for endoscopic interventions for at least 6 months. The primary outcome was to assess clinical effectiveness and adverse events. Secondary outcome was to identify factors that predicted the dysphagia-free period (the time interval of two subsequent endoscopic interventions). Multivariate analysis was used to estimate the risk factors influencing the treatment success. To explore the trend of dysphagia-free period along with times used hierarchical linear models. Results 75 patients (54 male; median age, 59 years) with RBES, 39 (52%), 20 (26.7%), 3 (4%), 10(13.3%), and 3(4%) were post-surgical, post-ESD, achalasia of cardia, caustic and mixed etiology, respectively. The median times of endoscopic therapy was 5 times (range 3, 21). Self-expandable metal stents (SEMSs) were placed in 20 patients (26.7%), and the success rate of patients treated with dilation (70.9%, 39/55) was higher than with stents (35%, 7/20). Fifteen patients died during follow-up. Nineteen patients had adverse events after endoscopic therapy. In total, the mean dysphagia-free period was 3.4 months (95% CI, 2.5–4.3). The dysphagia-free period of patients treated with dilation was 3.7months (95% CI, 2.7–5), and with stents was 2.3 months (95% CI, 1.5–3). The dysphagia-free period has linear growth trend with times, increased by 12 days per endoscopic therapy. Conclusion The dysphagia-free period increased by 12 days per endoscopic therapy, so the endoscopic dilation and stents tended to be effective in patients with RBES. Before the end of follow-up, nearly half of patients required continuing endoscopic dilation and stents, therefore, the patients with RBES may have negative long-term results. Stents therapy tended to not reduce the times and frequency of dilation. Disclosure All authors have declared no conflicts of interest.