Background: Benign strictures of the digestive tract remain a therapeutic challenge for gastroenterologists and surgeons. Whether anastomotic, chemical or induced by radiotherapy, those strictures are often treated by endoscopic balloon dilatation or bougienage but with a transient clinical benefit for the patient and the need to repeat the procedures. Stenting is a new modality which allows dilatation for weeks. However, metal stents are not indicated in benign diseases and plastic stents have a high rate of migration.
Objectives: To collect the Belgian experience with the newly developed ELLA stent. This stent has large flares and open mesh to avoid migration and is built with sugar polymers allowing its progressive digestion over around 2 months avoiding the need of a second look for stent removal.
Results: Twenty patients received a total of 24 ELLA-BD stents. Median age at stenting was 46 [11-72] years. The causes of strictures were post surgery in the upper GI tract in 17 (85%). These patients had a median of 14 [0-105] endoscopic procedures (dilatation, stents) before ELLA stenting over a median period of 17 [0-115] months. Median follow-up after ELLA stenting was 9 [0-18] months. The placement of the stent was easy in all but 2 cases (including 1 failure). Twelve patients presented mild to severe pain after stent placement (60%). The median primary patency of the stent (dysphagia relief without any intervention) was 90 [0-510] days. Eight patients (40%) did not need any reintervention during follow-up but some others developed severe mucosal hyperplasia persisting after stent removal and needing again iterative dilatations. The need for additional procedures after ELLA stenting was 52% after 6 months.
Conclusions: The concept of biodegradable stent is appealing for the treatment of benign strictures of the GI tract. However in its current design, the ELLA stent needs improvements to reduce post-procedural pain and hyperplasia. A better selection of patients who will benefit of this stent on the longterm is mandatory.