Review Article The Use of Self-Expanding Plastic Stents in the Management of Oesophageal Leaks and Spontaneous Oesophageal Perforations
L. H. Moyes, C. K. MacKay, and M. J. Forshaw
Department of Surgery, Oesophagogastric Unit, Royal Inﬁrmary, Glasgow G4 0SF, UKCorrespondence should be addressed to L. H. Moyes, lisa email@example.com Received 18 January 2011; Accepted 18 May 2011 Academic Editor: Tony C. K. Tham Copyright © 2011 L. H. Moyes et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited. Leakage after oesophageal anastomosis or perforation remains a challenge for the surgeon. Traditional management has been operative repair or intensive conservative management. Both treatments are associated with prolonged hospitalisation and high morbidity and mortality rates. Self-expanding metallic stents have played an important role in the palliation of malignant oesophageal stricturesand the treatment of tracheoesophageal ﬁstulae. However, self-expanding metal stents in benign oesophageal disease are associated with complications such as bleeding, food bolus impaction, stent migration, and diﬃculty in retrieval. The Polyﬂex stent is the only commercially available self-expanding plastic stent which has been used in the management of malignant oesophageal strictures with goodresults. This review will consider the literature concerning the use of self-expanding plastic stents in the treatment of oesophageal anastomotic leakage and spontaneous perforations of the oesophagus.
Stents have played an important role over the last few years for the palliation of malignant oesophageal strictures and the treatment of tracheoesophageal ﬁstulae . There areseveral types of commercial stents available, but they can largely be separated into two groups: metal or plastic stents. Self-expanding metal stents (SEMSs) are made of stainless steel (Z stent, Cook), nitinol (Ultraﬂex, Boston Scientiﬁc), or elgiloy (Wallstent, Boston Scientiﬁc) and may be uncovered, partially covered, or fully covered. Uncovered or partially covered stents (e.g., Ultraﬂex) allowﬁxing to the oesophageal lumen, but they have a tendency to become blocked due to tumour overgrowth. Fully covered metal stents (e.g., Niti-S) are beneﬁcial in controlling leakage and can be easily retrieved, but they are prone to migration. There is currently only one commercially available plastic stent on the market—the Polyﬂex stent produced by Boston Scientiﬁc. These stents have beensuccessfully used in the management of benign and malignant oesophageal strictures . SEMS replaced rigid metal stents in the 1990s and have been successfully used for the management of tracheoesophageal ﬁstulae and malignant strictures [3, 4]. They are
relatively easy to deploy, have a high success rate, and provide rapid symptom relief. There are also reports in the literature regarding the use ofSEMS for the successful treatment of benign oesophageal disease including perforations. However, these partially covered or uncovered SEMSs were associated with relatively high complication rates (26–52%) including bleeding, perforation, stent migration, pain, ingrowth, and food bolus impaction . As a result, many centres would not advocate the use of uncovered or partially covered stents inbenign disease . The Polyﬂex stent is a self-expanding plastic stent (SEPS) of polyester braid completely covered in silicone membrane. The proximal end is ﬂared to prevent dislocation and ensure reliable occlusion with radioopaque markers at both ends and in the middle to facilitate accurate placement. The Polyﬂex stent overcomes some of the disadvantages associated with SEMS allowing easier...