Benign peptic strictures can sometimes be refractory to endoscopic dilatations, with patients requiring frequent dilatations, with risk of complications. These patients have no other option for management except for surgery. Self-expanding plastic stents (SEPS) have been anecdotally used in some patients with a high incidence of migration leading to stent removal. Polydioxanone biodegradable stents have recently been introduced in the UK and this is a report of their use in the first 4 patients in the North East of England.Aims and Methods:
This pilot was carried out with the primary aim of assessing the feasibility of the Ella BD_ Polydioxanone stent (Ella-CS, Kralove, Czech Republic) in oesophageal dilatation in 4 patients with refractory benign oesophageal stricture. Secondary aims were to assess ease of insertion and placement, patient comfort, migration rates, disintegration times, dysphagia scores at 3 month intervals and complications if any. 4 patients with refractory benign oesophageal stricture, defined as symptomatic dysphagia O Grade2 despite endoscopic dilatation to 15mm in the previous 6 months or requiring more than 3 dilatation sessions over the previous 12 months were offered the Ella BD_ stent placement. The stent was placed under fluoroscopic and endoscopic visualisation with conscious sedation. Patients were followed up clinically every 4 weeks and endoscopy carried out at 4-6 weeks intervals to assess stent disintegration. Dysphagia assessment was done at 3 months post stent disintegration.Results:
- The Ella BD stent is cumbersome to load onto the delivery device although improvements have been made to the second generation of the stent.
- Stent placement is easy, and the second generation of stents have better radiological visualisation due to circumferential markers.
- 1 patient had moderately severe discomfort after stent placement requiring analgesics over 2 days.
- No displacement reported or seen at endoscopy in 3 patients; 2cm proximal displacement seen in third patient.
- Stent disintegration occurs around 10-12 weeks.
- Follow up range: 4-17 weeks. No need for dilatation in any patient and no recurrence of dysphagia at 3months post disintegration in 2 patients.
The Polydioxanone stent is a feasible option for management of refractory benign oesophageal strictures. Its use may be associated with fewer endoscopic procedures and cost reduction. However, design improvements and large studies are needed before they can be part of the management algorithm.