Usage of self-expandable metallic stents (SEMS) in benign esophageal diseases

Öz

We used self-expandable metallic stents in benign disease-related fistulas of the esophagus and report our experience pertaining to three cases. All the cases were implanted with retrievable stents under direct endoscopic view and fluoroscopic control. The fistulas were closed within two weeks in all cases. While one of the stents was endoscopically retrieved, the other two were not taken out due to the adverse general condition of the patients. In benign esophageal fistulas, SEMS can be an alternative to surgical intervention because of their easiness of placement and the possibility of retrieval at an early stage.

Anahtar Kelimeler

• Benign esophageal disease, metallic stent

Benign özefageal hastalıklarda kendiliğinden genişleyen kaplı metal stent (SEMS) kullanımı

Öz

Benign özofagus hastalıklarına bağlı fistüllerde kendiliğinden genişleyen kaplı metal stentlerin kullanımını 3 olguda değerlendirdik. Tüm olgulara çıkarılabilir stentler endoskopik olarak direkt görüş altı nda ve floroskopik kontrol yapılarak yerleştirildi. Olguların tümünde fistülün 2 hafta sonra kapanmış olduğu görüldü. Stentlerin 1 olguda endoskopik olarak çıkarılırken, diğer iki stent hasta genel durumu bozukluğu nedeniyle çıkarılmadı. Benign özofagus fistüllerinde metal stent kolay yerleştirilmeleri, erken dönemde çıkarılabilmeleri nedeniyle cerrahi girişime alternatif olarak seçilmiş vakalarda kullanılabilirler.

Anahtar Kelimeler

• Benign özofagus hastalığı, metal stent

Kaynakça

1. Nelson DB, Axelrad AM, Fleischer DE, et al. Silicone covered Wallstent prototypes for palliation of malignant esophageal obst- ruction and digestive-respiratory fistulas. Gastrointest Endosc 1997; 45: 31-7.
2. Wadhwa RP, Kozarek RA, France RE, et al. Use of self-expandable metallic stents in benign GI diseases. Gastrointest Endosc 2003; 58: 207-12.
3. Moses FM, Wong RK. Stents for Esophageal Disease. Curr Treat Options Gastroenterol 2002; 5: 63-71.
4. Kozarek RA, Raltz S, Marcon N, et al. Use of the 25 mm flanged esophageal Z stent for malignant dysphagia: A prospective multi- center trial. Gastrointest Endosc 1997; 46: 156-60.
5. Raijman I, Siddique I, Ajani J, et al. Palliation of malignant dyspha- gia and fistulae with coated expandable metal stents: Experience with 101 patients. Gastrointest Endosc 1998; 48: 172-9.
6. Knyrim K, Wagner HJ, Bethge N, et al. A controlled trial of an ex- pansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med 1993; 329: 1302-7 .
7. Cwikiel W, Willen R, Stridbeck H, et al. Self-expanding stent in the treatment of benign esophageal strictures: Experimental study in pigs and presentation of clinical cases. Radiology 1993; 187: 667- 71.
8. Sandha GS, Marcon NE. Expandable metal stents for benign esop- hageal obstruction. Gastrointest Endosc Clin North Am 1999; 9: 437-46.

9. Boulis NM, Armstrong WS, Chandler WF, et al. Epidural abscess: A delayed complication of esophageal stenting for benign stricture. Ann Thorac Surg 1999; 68: 568-70.
10. Radecke K, Gerken G, Treichel U. Impact of a self-expanding, plas- tic esophageal stent on various esophageal stenoses, fistulas, and le- akages: a single-center experience in 39 patients. Gastrointest En- dosc 2005; 61: 812-8.
11. Dumonceau JM, Cremer M, Lalmand B, et al. Esophageal fistula se- aling: Choice of stent, practical management, and cost. Gastrointest Endosc 1999; 49: 70-8.
12. Adam A, Watkinson AF, Dussek J. Boerhaave syndrome: to treat or not to treat by means of insertion of a metallic stent. J Vasc Inter- vent Radiol 1995; 6: 741-6.
13. Yuasa N, Hattori T, Kobayashi Y, et al. Treatment of spontaneous esophageal rupture with a covered self-expanding metal stent. Gast- rointest Endosc 1999; 49: 777-8.
14. Johnsson E, Lundell L, Liedman B. Sealing of esophageal perfora- tion or ruptures with expandable metallic stents: A prospective cont- rolled study on treatment efficacy and limitations. Dis Esophagus 2005; 18: 262-6.
15. Eubanks PJ, Hu E, Nguyen D, et al. Case of Boerhaave's syndrome successfully treated with a self-expanding metallic stent. Gastroin- test Endosc 1999; 49: 780-3.
16. Low DE, Kozarek RA. Removal of esophageal expandable metal stents: description of technique and review of potential applications. Surg Endosc 2003; 17: 990-6 .
17. Goldin E, Fiorini A, Ratan Y, et al. A new biodegradable and self- expanding stent for benign esophageal strictures. Gastrointest En- dosc 1996; 43: 294 (abstract)
18. Fry SW, Fleischer DE. Management of a refractory benign esopha- geal stricture with a new biodegradable stent. Gastrintest Endosc 1997; 45: 179-82.