Use of a fully covered self-expandable metal stent for the treatment of benign esophageal diseases

Background: Fully covered self-expandable metal stents (FCSEMSs) have been proposed for the treatment of benign esophageal diseases. Objective: To review our experience with FCSEMSs in patients with benign esophageal diseases. Design: Retrospective case review of patients who underwent FCSEMS placement for benign esophageal diseases, including (1) benign strictures from GERD-caustic and idiopathic causes, (2) radiation-induced strictures, (3) anastomotic strictures, (4) esophageal fistulae/leaks, and (5) esophageal perforations. Setting: Tertiary-care medical center. Patients: This study involved 37 male and 19 female patients (average age 60 years, range 25-94 years) who underwent FCSEMS placement. Intervention: FCSEMS placement. Main Outcome Measurements: Technical success with stent placement and removal, stent migration, long-term and short-term complications, and treatment success according to clinical symptoms, follow-up endoscopy, or imaging. Results: Stent placement was successful in 100 of 107 (93%) procedures, with a total of 104 stents placed. Migration was noted in 37 of 104 (35.6%) stents and was seen more frequently with proximal stents and stents placed for anastomotic strictures. Initial treatment success was seen in 56% of patients with any stricture and in 38% of patients with a fistula/leak or perforation, although data to document long-term resolution were lacking. Limitations: This was a retrospective review with patients selected from a tertiary-care medical center. Two endoscopists performed the majority of procedures. Conclusion: Temporary placement of FCSEMSs for benign esophageal diseases has moderate clinical efficacy and is limited by stent migration. Removability was easily demonstrated. Newer developments in stent design may improve clinical outcomes for these patients. (Gastrointest Endosc 2010;72:712-20.)