Suzuki Takayuki, Siddiqui Ali, Taylor Linda J, Cox Kristen, Hasan Raza A, Laique Sobia N, Mathew Arun, Wrobel Piotr, Adler Douglas G
*Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT †Department of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, PA.
J Clin Gastroenterol. 2016 May-Jun;50(5):373-8. doi: 10.1097/MCG.0000000000000500.
Esophageal stents are commonly used to treat benign esophageal conditions including refractory benign esophageal strictures, anastomotic strictures, fistulae, perforations and anastomotic leaks. Data on outcomes in these settings remain limited.
We performed a retrospective multicenter study of patients who underwent fully or partially covered self-expandable stent placement for benign esophageal diseases. Esophageal stent placements were performed for the following indications: (1) benign refractory esophageal strictures, (2) surgical anastomotic strictures, (3) esophageal perforations, (4) esophageal fistulae, and (5) surgical anastomotic leaks.
A total of 70 patients underwent esophageal stent placement for benign esophageal conditions. A total of 114 separate procedures were performed. The most common indication for esophageal stent placement was refractory benign esophageal stricture (48.2%). Global treatment success rate was 55.7%. Treatment success rate was 33.3% in refractory benign strictures, 23.1% in anastomotic strictures, 100% in perforations, 71.4% in fistulae, and 80% in anastomotic leaks. Stent migration was noted in 28 of 70 patients (40%), most commonly seen in refractory benign strictures.
This is one of the largest studies to date of esophageal stents to treat benign esophageal diseases. Success rates are lowest in benign esophageal strictures. These patients have few other options beyond chronic dilations, feeding tubes, and surgery, and fully covered self-expandable metallic stent give patients a chance to have their problem fixed endoscopically and still eat by mouth. Perforations, fistulas, and leaks respond very well to esophageal stenting, and stenting should be considered as a first-line therapy in these settings.
食管支架常用于治疗良性食管疾病，包括难治性良性食管狭窄、吻合口狭窄、瘘、穿孔和吻合口漏。这些情况下的治疗结果数据仍然有限。
我们对因良性食管疾病接受全覆膜或部分覆膜自膨式支架置入术的患者进行了一项回顾性多中心研究。食管支架置入术的适应证如下：（1）良性难治性食管狭窄，（2）手术吻合口狭窄，（3）食管穿孔，（4）食管瘘，（5）手术吻合口漏。
共有70例患者因良性食管疾病接受了食管支架置入术。共进行了114例单独手术。食管支架置入术最常见的适应证是难治性良性食管狭窄（48.2%）。总体治疗成功率为55.7%。难治性良性狭窄的治疗成功率为33.3%，吻合口狭窄为23.1%，穿孔为100%，瘘为71.4%，吻合口漏为80%。70例患者中有28例（40%）出现支架移位，最常见于难治性良性狭窄。
这是迄今为止关于食管支架治疗良性食管疾病的最大规模研究之一。良性食管狭窄的成功率最低。除了长期扩张、鼻饲管和手术外，这些患者几乎没有其他选择，而全覆膜自膨式金属支架为患者提供了通过内镜解决问题并仍能经口进食的机会。食管支架置入术对穿孔、瘘和漏的治疗效果非常好，在这些情况下应考虑将支架置入术作为一线治疗方法。
