title: The use of biodegradable stents in malignant oesophageal strictures for the treatment of dysphagia before neoadjuvant treatment or radical radiotherapy: a feasibility study.
abstract: OBJECTIVE
  To evaluate the clinical results of the use of biodegradable oesophageal stents in malignant strictures.
  
  
  METHODS
  Eleven patients were included in this prospective analysis in which a woven polydioxanone biodegradable oesophageal stent was used. The inclusion criterion was that the patient underwent neoadjuvant treatment or radical radiotherapy after the stent insertion. Primary end points were dysphagia score at discharge, stent patency, and complication rate. Secondary end points were overall survival and surgical outcome of surgery.
  
  
  RESULTS
  There was a 100% procedure technical success rate. Early complications occurred in three patients resulting in failure to restore oral nutrition. In the remaining eight patients, dysphagia was significantly improved at discharge. Mean stent patency rate in this group was 71.5 days. Stent dysfunction occurred in five of eight patients (62.5%); in two of five patients this was due to local inflammatory reaction, and in three of five patients it was due to tumour growth after a mean time of 97.8 days, and a new metallic stent was consequently placed in four of five patients. One patient was successfully treated with esophagectomy. At the end of follow-up (mean time 102.1 days), three of eight stents were patent. The overall patient survival rate was 81.8%.
  
  
  CONCLUSIONS
  Although short-term dysphagia scores improved, biodegradable stents do not appear to offer a clear beneficial effect in most cases of malignant strictures, particularly due to a local inflammatory reaction that may be induced. Technical improvement of the device and delineation of the patient group that would benefit from its use is necessary if further studies are to be conducted in the future.
authors.affiliation: Department of Radiology, Guy's and St. Thomas' NHS Trust, St Thomas' Hospital, 1st Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH, UK. mkrokidis@hotmail.com
authors.forename: Miltiadis
authors.initials: M
authors.lastname: Krokidis
authors.forename: Chris
authors.initials: C
authors.lastname: Burke
authors.forename: Stavros
authors.initials: S
authors.lastname: Spiliopoulos
authors.forename: Panos
authors.initials: P
authors.lastname: Gkoutzios
authors.forename: Orla
authors.initials: O
authors.lastname: Hynes
authors.forename: Irfan
authors.initials: I
authors.lastname: Ahmed
authors.forename: Renato
authors.initials: R
authors.lastname: Dourado
authors.forename: Tarun
authors.initials: T
authors.lastname: Sabharwal
authors.forename: Robert
authors.initials: R
authors.lastname: Mason
authors.forename: Andreas
authors.initials: A
authors.lastname: Adam
mesh_terms: D020341:Absorbable Implants; D000368:Aged; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D004940:Esophageal Stenosis / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D010166:Palliative Care / Q000379:methods; D016687:Polydioxanone; D011446:Prospective Studies; D011474:Prosthesis Design; D011788:Quality of Life; D011882:Radiotherapy, High-Energy / Q000379:methods; D018570:Risk Assessment; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D016687:Polydioxanone