Esophageal Stent Placement for Benign Esophageal Strictures, Leaks, Fistulas and Perforations (pp. 249-258)
Authors: (Disaya Chavalitdhamrong, Peter V. Draganov, Mihir S. Wagh, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA)
Abstract: Traditionally, endoscopic esophageal stent placement has been used for palliation in malignant esophageal conditions. Temporary stent insertion for benign esophageal diseases has been increasingly used lately. This chapter focuses on the role of esophageal stents in benign esophageal diseases.
Endoscopic esophageal stent placement has been reported and used for the treatment of benign strictures, anastomotic strictures, leaks, fistulas and perforations. Esophageal stent placement is a viable alternative to serial esophageal dilation for benign refractory strictures, and is an effective alternative to operative repair for selected esophageal leaks, fistulas and perforations to avoid the potential morbidity from complex surgery. Esophageal stents have rapidly evolved from rigid, plastic tubes to partially covered self-expanding metal stents (SEMSs) and self-expanding plastic stents (SEPSs). Recently, fully covered SEMSs and biodegradable stents have been introduced.
This chapter reviews the various types of stents, their characteristics, efficacies, and complications. An optimal stent design should be flexible, nontraumatic, and have a large enough internal diameter to allow normal food passage. Furthermore, stents that are easy to remove, reposition, and replace, with reduced rates of migration and less tissue reaction are desired.