Department of Gastroenterology and Hepatology, University Medical Center Utrecht, the Netherlands.
Clin Gastroenterol Hepatol. 2011 Aug;9(8):653-9. doi: 10.1016/j.cgh.2011.04.006. Epub 2011 Apr 15.
BACKGROUND & AIMS: It is a challenge to manage refractory benign esophageal strictures (RBES). We compared the efficacy and safety of self-expanding plastic stents (SEPSs) with placement of biodegradable stents for the treatment of RBES.
We studied 2 groups of consecutive patients with RBES who received temporary placement (6 weeks) of SEPSs (n = 20) or biodegradable stents (n = 18). Data were collected with respect to clinical outcome, complications, recurrent dysphagia, and reinterventions.
SEPSs were removed in 16 (80%) patients. Stent placement was not successful in 1 patient, while stent removal was not performed in another 3 patients. Six (30%) patients with an SEPS were dysphagia-free after a median follow-up of 385 days (range, 77-924 days). Ten (50%) developed recurrent dysphagia. Major complications occurred in 2 patients (10%; 1 with hemorrhage and 1 with perforation). Six patients (33%) with a biodegradable stent were dysphagia-free after a median follow-up of 166 days (range 21-559 days) (P = .83 compared with SEPS). Twelve patients (67%) had recurrent dysphagia. Major complications occurred in 4 patients (22%; 2 with hemorrhage, 2 with severe retrosternal pain) with a biodegradable stent (P = .30 compared with SEPS). Reinterventions were less frequently indicated after biodegradeble stent than after SEPS placement (15 [mean, 0.8 ± 0.6 per stent placed] vs 21 [mean, 1.3 ± 0.4 per stent placed], respectively; P = .03).
Placement of SEPSs or biodegradable stents provides long-term relief of dysphagia in 30% and 33%, respectively, of patients with RBES. Biodegradable stents require fewer procedures than SEPSs, offering an advantage. Although stent placement is a viable strategy in patients with RBES, the ideal strategy still needs to be defined.
治疗难治性良性食管狭窄（RBES）具有挑战性。我们比较了自膨式塑料支架（SEPS）和可生物降解支架置入治疗 RBES 的疗效和安全性。
我们研究了两组连续的 RBES 患者，他们接受了 SEPS（n = 20）或可生物降解支架（n = 18）的临时置入（6 周）。收集了临床结果、并发症、复发性吞咽困难和再介入的数据。
SEPS 在 16 例（80%）患者中被取出。1 例患者支架置入不成功，另有 3 例患者未取出支架。在中位随访 385 天（范围 77-924 天）后，16 例 SEPS 患者中有 6 例（30%）无吞咽困难。10 例（50%）患者出现复发性吞咽困难。2 例患者（10%；1 例出血，1 例穿孔）出现主要并发症。在中位随访 166 天（范围 21-559 天）后，18 例可生物降解支架中有 6 例（33%）无吞咽困难（与 SEPS 相比，P =.83）。12 例（67%）患者出现复发性吞咽困难。4 例（22%；2 例出血，2 例严重胸骨后疼痛）使用可生物降解支架出现主要并发症（与 SEPS 相比，P =.30）。与 SEPS 放置相比，可生物降解支架后再介入的频率较低（分别为 15[平均，每个支架放置 0.8 ± 0.6]和 21[平均，每个支架放置 1.3 ± 0.4]；P =.03）。
SEPS 或可生物降解支架置入分别为 30%和 33%的 RBES 患者提供长期吞咽困难缓解。可生物降解支架比 SEPS 支架需要更少的操作，具有优势。尽管支架置入是 RBES 患者的一种可行策略，但仍需要确定理想的策略。
