Polyflex expandable stents in the treatment of esophageal disease: initial experience.
BACKGROUND
The new generation of expandable plastic esophageal stents (Polyflex; Boston Scientific, Natick, MA), combine the features of plastic and self-expanding metallic stents. The main objective of this study is to evaluate our initial experience with Polyflex expandable stents in the treatment of esophageal disease from two institutions.


METHODS
A total of 58 Polyflex stents were placed in 38 patients over a two-year period. There were 24 men and 14 women, with a median age of 63 years (range, 25 to 83). The most common indication for placement was an esophageal stricture in 25 patients (66%); other causes included leak in 8 (21%) and tracheoesophageal fistula (TEF) in 5 (13%). We evaluated the hospital course, complications, and outcomes.


RESULTS
The median postoperative stay was one day. Complications included migration in 38 stents (63%) (28 patients; 73%), retrosternal chest discomfort in nine, reflux in four, airway obstruction in one, and food impaction in three. Continued leak or a persistent TEF occurred in five patients (38%). Reintervention was required predominantly due to migration of the stent at a mean interval of 46 days (range, 1 to 353). Patients with dysphagia improved significantly with dysphagia scores (1 = no dysphagia; 5 = unable to swallow saliva) improving from 3.44 to 2.15 (p < 0.0001).


CONCLUSIONS
Polyflex stents were effective in the relief of dysphagia due to strictures. They were less effective in esophageal perforations or leaks. Their primary disadvantage is a high migration rate and further improvements in design are required to decrease this high incidence of migration.
Pennathur
Arjun
A
Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Chang
Andrew C
AC
McGrath
Kevin M
KM
Steiner
Gregory
G
Alvelo-Rivera
Miguel
M
Awais
Omar
O
Gooding
William E
WE
Christie
Neil A
NA
Gilbert
Sebastien
S
Landreneau
Rodney J
RJ
Luketich
James D
JD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004937:Esophageal Fistula / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020959:Polyethylene; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D012826:Silicone Elastomers; D015607:Stents; D014138:Tracheoesophageal Fistula / Q000601:surgery*; D016896:Treatment Outcome
D012826:Silicone Elastomers; D020959:Polyethylene