Comparison of a standard fully covered stent with a super-thick silicone-covered stent for the treatment of refractory esophageal benign strictures: A prospective multicenter study

Ulriikka Chaput; Denis Heresbach; Etienne Audureau; Geoffroy Vanbiervliet; Marianne Gaudric; Philippe Bichard; Paul Bauret; Dimitri Coumaros; Thierry Ponchon; Fabien Fumex; Emmanuel Bensoussan; Hervé Lamouliatte; Ariane Chryssostalis; Françoise Robin; Frédéric Prat

doi:10.1177/2050640613476501

Comparison of a standard fully covered stent with a super-thick silicone-covered stent for the treatment of refractory esophageal benign strictures: A prospective multicenter study

United European Gastroenterol J. 2013 Apr;1(2):93-102. doi: 10.1177/2050640613476501.

Authors

Affiliations

¹ Hepato-gastroenterology Department, Université Paris-Descartes, Hôpital Cochin, Paris, France.
² Hepato-gastroenterology Department, Hôpital Pontchaillou, Rennes, France.
³ Biostatistical and Epidemiology Unit, Hôpital Hôtel Dieu, Université Paris Descartes, Paris, France.
⁴ Hepato-gastroenterology Department, Hôpital de l'Archet, Nice, France.
⁵ Hepato-gastroenterology Department, Centre Hospitalier Universitaire La Tronche, Grenoble, France.
⁶ Hepato-gastroenterology Department, Hôpital Saint Eloi, Montpellier, France.
⁷ Hepato-gastroenterology Department, Hôpital Civil de Strasbourg, Strasbourg, France.
⁸ Hepato-gastroenterology Department, Hôpital Edouard Herriot, Lyon, France.
⁹ Hepato-gastroenterology Department, Centre Hospitalier Universitaire de Saint-Etienne, Hôpital Nord, Saint Priest en Jarez, France.
¹⁰ Hepato-gastroenterology Department, Clinique de l'Alma, Paris, France.
¹¹ Hepato-gastroenterology Department, Hôpital Saint-André, Bordeaux, France.
¹² Société Française d'Endoscopie Digestive, Lyon and Paris, France.

Abstract

Background: Some esophageal strictures resist endoscopic treatments. There is a need for new treatments, such as specifically designed stents.

Objective: Our study sought to compare the results achieved with a standard, fully covered metallic stent (FCMS) and those achieved using a stent designed specifically for benign strictures (BS-FCMS).

Patients and methods: The study used a prospective, multicenter, controlled design, with patients recruited from tertiary referral centers. Patients with refractory esophageal strictures were included. Standard FCMS were used in group 1 (N = 24), and BS-FCMS were used in group 2 (N = 17). Patients were followed for 24 months after stent removal. The main outcomes measured were stricture resolution rate, 24 months' recurrence rate and stent-related morbidity.

Results: Early stent migrations occurred in one (4.1%) patient from group 1 and five (29.4%) from group 2 (p < 0.05). During esophageal stenting, complications occurred in six patients (25%) in group 1 and six patients (35.3%) in group 2 (p = 0.47), respectively. Fifty percent of complications were attributed to migration. There was no procedure-related morbidity associated with the extraction of the stent. The stricture resolution rate was, respectively, 95.2% in group 1 and 87.5% in group 2 (the difference between the two groups is not significant). During follow-up, stricture recurrence occurred in 15/19 patients (group 1, 79%) and 7/8 patients (group 2, 87.5%; p = 1.0). The median time to recurrence of esophageal stricture was 1.7 months (group 1, 0.6-12 months) and 1 month (group 2, 0.1-6 months). Study limitations include its nonrandomized design.

Conclusion: The stricture resolution rate was high at the end of the stenting period for both types of stents without any statistical difference between the two groups, but the long-term results were disappointing, with stricture recurring frequently and rapidly in both groups.

Keywords: Benign esophageal stricture; fully covered self-expandable metallic stent; refractory stricture.