Safety and efficacy of esophageal stents for esophageal anastomotic strictures: A 10-year single-center experience
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Background: The aim of this study was to determine whether esophageal stent placement in recurrent and refractory post-esophagectomy anastomotic strictures improves clinical outcomes and prolongs the intervals between re-interventions. Methods: This retrospective, observational, single-center study analyzed data from all patients who underwent esophageal stent placement for symptomatic benign post-esophagectomy anastomotic strictures from 2009 to 2019. The primary outcome was technical and clinical success. The secondary outcomes were stent-related complications and re-intervention duration and rates. Results: Twenty-eight patients underwent esophageal stent placement for post-esophagectomy benign anastomotic strictures. The technical success rate was 96.4%. The clinical success rates at 4 weeks, 12 weeks, and 1 year were 100%, 69.23%, and 72.72%, respectively. Serious stent-related complications occurred in two patients (7.1%), while minor adverse events were noted in 11 patients (39.28%). The rate of stricture recurrence with a mean dysphagia-free interval of 17 weeks after stent placement was 64.28%. The rate of luminal patency with a stent was 73.33% at 12 months. Conclusion: Stent insertion is an effective and safe treatment modality for anastomotic esophageal strictures. Long-term remission of the stricture, more luminal patency, and an improved dysphagia score were observed, but the findings need to be confirmed through multivariate analysis.
Abstract
Background: The aim of this study was to determine whether esophageal stent placement in recurrent and refractory post-esophagectomy anastomotic strictures improves clinical outcomes and prolongs the intervals between re-interventions. Methods: This retrospective, observational, single-center study analyzed data from all patients who underwent esophageal stent placement for symptomatic benign post-esophagectomy anastomotic strictures from 2009 to 2019. The primary outcome was technical and clinical success. The secondary outcomes were stent-related complications and re-intervention duration and rates. Results: Twenty-eight patients underwent esophageal stent placement for post-esophagectomy benign anastomotic strictures. The technical success rate was 96.4%. The clinical success rates at 4 weeks, 12 weeks, and 1 year were 100%, 69.23%, and 72.72%, respectively. Serious stent-related complications occurred in two patients (7.1%), while minor adverse events were noted in 11 patients (39.28%). The rate of stricture recurrence with a mean dysphagia-free interval of 17 weeks after stent placement was 64.28%. The rate of luminal patency with a stent was 73.33% at 12 months. Conclusion: Stent insertion is an effective and safe treatment modality for anastomotic esophageal strictures. Long-term remission of the stricture, more luminal patency, and an improved dysphagia score were observed, but the findings need to be confirmed through multivariate analysis.
참고문헌 (27)
- Mendelson AH, "Esophageal anastomotic strictures : outcomes of endoscopic dilation, risk of recurrence and refractory stenosis, and effect of foreign body removal", Clin Gastroenterol Hepatol, 13, pp.263~271 (2015)
- Wu P, "Comparison of esophageal stent placement versus endoscopic incision method for treatment of refractory esophageal anastomotic stricture", Ann Palliat Med, 8, pp.462~468 (2019)
- Burr NE, "Management of benign oesophageal strictures", Frontline Gastroenterol, 10, pp.177~181 (2019)
- Sigounas DE, "Biodegradable esophageal stents in benign and malignant strictures-a single center experience", Endosc Int Open, 4, pp.E618~23 (2016)
- Park JY, "Benign anastomotic strictures after esophagectomy : long-term effectiveness of balloon dilation and factors affecting recurrence in 155 patients", AJR Am J Roentgenol, 198, pp.1208~1213 (2012)
- Kappelle WF, "Treatment of refractory post-esophagectomy anastomotic esophageal strictures using temporary fully covered esophageal metal stenting compared to repeated bougie dilation : results of a randomized controlled trial", Endosc Int Open, 7, pp.E178~85 (2019)
- Larson B, "Lumen-apposing metal stents for gastrointestinal luminal strictures : current use and future directions", Ann Gastroenterol, 32, pp.141~146 (2019)
- Repici A, "Systematic review : the role of self-expanding plastic stents for benign oesophageal strictures", Aliment Pharmacol Ther, 31, pp.1268~1275 (2010)
- Muto M, "Usefulness of endoscopic radial incision and cutting method for refractory esophagogastric anastomotic stricture(with video)", Gastrointest Endosc, 75, pp.965~972 (2012)
- Canena JM, "A comparison of the temporary placement of 3 different self-expanding stents for the treatment of refractory benign esophageal strictures : a prospective multicentre study", BMC Gastroenterol, 12, pp.70~ (2012)
- 최철웅, "양성 식도 수술 문합부 협착에 대한 확장 치료의 임상 결과", 대한소화기학회지, 69(2), pp.102~108 (2017), 대한소화기학회
- Van der Bogt RD, "Stents for benign esophageal strictures", Tech Innov Gastrointest Endosc, 22, pp.200~204 (2020)
- Fuccio L, "Clinical outcomes following stent placement in refractory benign esophageal stricture : a systematic review and meta-analysis", Endoscopy, 48, pp.141~148 (2016)
- Young Hee Ham, "Plastic and Biodegradable Stents for Complex and Refractory Benign Esophageal Strictures", Clinical Endoscopy, 47(4), pp.295~300 (2014), 대한소화기내시경학회
- Vermeulen BD, "Esophageal stenting in clinical practice : an overview", Curr Treat Options Gastroenterol, 16, pp.260~273 (2018)
- Liu J, "Removable, fully covered, self-expandable metal stents for the treatment of refractory benign esophagogastric anastomotic strictures", Dysphagia, 27, pp.260~264 (2012)
- Repici A, "Natural history and management of refractory benign esophageal strictures", Gastrointest Endosc, 84, pp.222~228 (2016)
- Martin RC, "The use of self-expanding silicone stents in esophagectomy strictures : less cost and more efficiency", Ann Thorac Surg, 86, pp.436~440 (2008)
- Yano T, "Prospective trial of biodegradable stents for refractory benign esophageal strictures after curative treatment of esophageal cancer", Gastrointest Endosc, 86, pp.492~499 (2017)
- Bazerbachi F, "Safety and efficacy of coaxial lumen-apposing metal stents in the management of refractory gastrointestinal luminal strictures : a multicenter study", Endosc Int Open, 5, pp.E861~7 (2017)
- Everett SM, "Endoscopic management of refractory benign oesophageal strictures", Ther Adv Gastrointest Endosc, 12, pp.2631774519862134~ (2019)
- Speer E, "Covered stents in cervical anastomoses following esophagectomy", Surg Endosc, 30, pp.3297~3303 (2016)
- Anderson MJ, "Endoscopic stent placement : indications and success rates", Ann Laparosc Endosc Surg, 4, pp.55~ (2019)
- Spaander MC, "Esophageal stenting for benign and malignant disease : European Society of Gastrointestinal Endoscopy(ESGE)clinical guideline", Endoscopy, 48, pp.939~948 (2016)
- Bakken JC, "Use of a fully covered self-expandable metal stent for the treatment of benign esophageal diseases", Gastrointest Endosc, 72, pp.712~720 (2010)
- Walter D, "Dilation or biodegradable stent placement for recurrent benign esophageal strictures : a randomized controlled trial", Endoscopy, 50, pp.1146~1155 (2018)
- Thomas S, "Fully-covered esophageal stent migration rates in benign and malignant disease : a multicenter retrospective study", Endosc Int Open, 7, pp.E751~6 (2019)