title: The use of self-expanding silicone stents in esophagectomy strictures: less cost and more efficiency.
abstract: BACKGROUND
  Benign and postoperative anastomotic esophageal strictures remain a common problem in the management of esophageal diseases and cancer. Repeated dilation remains the most common treatment algorithm. Esophageal stenting with a removable plastic stent is another option. This study evaluated the dysphagia effects and cost of removable silicone stents in the management of benign and postoperative anastomotic strictures compared with standard repeat dilation.
  
  
  METHODS
  A matched case-control study was done of benign esophageal stricture treatments from July 2004 to August 2006 in all patients treated for benign esophageal strictures identified in a prospectively maintained esophageal database. Eighteen patients had a retrievable silicone-covered stent placed, and 24 were treated with standard repeated dilations without stents. Early esophageal stenting vs repeated dilation in esophagectomy strictures and other benign strictures was compared.
  
  
  RESULTS
  The median number of dilatations was two (range, 1 to 3) for the 18 stent patients, with all stents placed for 3 months' duration, and four dilations (range, 2 to 12) in 24 patients treated solely with dilatation. An evaluation of median, high, and low total charges, net revenue, and direct margin demonstrated that the use of a removable stent after one failed dilation was more cost-efficient than repeated dilations.
  
  
  CONCLUSIONS
  In patients who do not respond to initial dilation, placement of removable esophageal stent at the second dilation leads to improved quality of life and dysphagia relief. Early use of a removable esophageal stent is significantly more cost-efficient when two or more esophageal dilations are avoided.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, Kentucky, USA. robert.martin@louisville.edu
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.forename: Charles
authors.initials: C
authors.lastname: Woodall
authors.forename: Ryan
authors.initials: R
authors.lastname: Duvall
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D016022:Case-Control Studies; D002404:Catheterization / Q000191:economics; D004940:Esophageal Stenosis / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects; D004945:Esophagoscopy / Q000191:economics; D005260:Female; D006801:Humans; D007629:Kentucky; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011788:Quality of Life; D015607:Stents / Q000191:economics