Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-27T13:33:56.907Z Has data issue: false hasContentIssue false
  • English
  • Français

Biodegradable oesophageal stents: A potentially useful adjunct in the treatment of dysphagia in patients undergoing radiotherapy for oesophageal carcinoma

Published online by Cambridge University Press:  29 April 2019

K White ,
S Thampy ,
H Sheikh ,
L Bhatt ,
D Mullan  and
H-U Laasch
K White
Affiliation:
Department of Interventional Radiology, The Christie NHS Foundation Trust, Manchester, UK
S Thampy*
Affiliation:
Department of Interventional Radiology, The Christie NHS Foundation Trust, Manchester, UK
H Sheikh
Affiliation:
Department of Interventional Radiology, The Christie NHS Foundation Trust, Manchester, UK
L Bhatt
Affiliation:
Department of Interventional Radiology, The Christie NHS Foundation Trust, Manchester, UK
D Mullan
Affiliation:
Department of Interventional Radiology, The Christie NHS Foundation Trust, Manchester, UK
H-U Laasch
Affiliation:
Department of Interventional Radiology, The Christie NHS Foundation Trust, Manchester, UK
*
Author for correspondence: Damian Mullan, Department of Interventional Radiology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK. Tel +441619182498. E-mail: damian.mullan@christie.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim:

Dysphagia is common in patients presenting with oesophageal malignancy. This study aimed to determine the clinical effectiveness of biodegradable stents to help with malignant dysphagia due to radiotherapy for oesophageal cancer and furthermore to establish the complication and re-intervention rates associated with their use.

Methods:

This was a retrospective, observational study of 22 patients between 2008 and 2013. Complications within 2 weeks and episodes of re-intervention required within 4 months of stent insertion prior to radiotherapy were recorded.

Results:

Pre-stent insertion, the mean O’Rourke dysphagia score was 3·5 (median 3, range 2–5). This improved to a mean score of 2·8 (median 3, range 1–4) 1–3 weeks following stent insertion. Complications occurred in seven patients (32%) in an immediate 2-week period, including: pain (2), dysphagia requiring dilatation (1), food obstruction not requiring intervention (1), food obstruction requiring intervention (2) and upper gastrointestinal bleed not requiring intervention (1). Re-intervention was required in 18% within a 4-month period.

Findings:

We propose that biodegradable oesophageal stents are safe and may have benefit over self-expanding metal stents. We recommend they are placed alongside a radiologically inserted gastrostomy in a combined procedure prior to radiotherapy planning.

Keywords

Biodegradable stentdysphagiamalignancyoesophagealradiotherapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 18 , Issue 4 , December 2019 , pp. 312 - 317
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cancer Research UK. Oesophageal cancer incidence statistics. 2015. http://www.cancerresearchuk.org/cancer-info/cancerstats/types/oesophagus/incidence/uk-oesophageal-cancer-incidence-statistics. Accessed on 24th November 2015.Google Scholar
Vizcaino, AP, Moreno, V, Lambert, R, Parkin, DM. Time trends incidence of both major histologic types of esophageal carcinomas in selected countries, 1973–1995. Int J Cancer 2002; 99 (6): 860–868.10.1002/ijc.10427CrossRefGoogle ScholarPubMed
Leichman, L, Thomas, CR Jr. Squamous cell cancer of the esophagus: the forgotten one. Gastrointest Cancer Res 2011; 4 (1): 22–23.Google ScholarPubMed
Allum, WH, Stenning, SP, Bancewicz, J, Clark, PI, Langley, RE. Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer (1527-7755 (Electronic)).Google Scholar
Allum, WH, Blazeby, JM, Griffin, SM, et al. Guidelines for the management of oesophageal and gastric cancer. Gut 2011; 60 (11): 1449–1472.10.1136/gut.2010.228254CrossRefGoogle ScholarPubMed
Lagergren, P, Avery, KN, Hughes, R, et al. Health-related quality of life among patients cured by surgery for esophageal cancer. Cancer 2007; 110 (3): 686–693.10.1002/cncr.22833CrossRefGoogle ScholarPubMed
Nitenberg, G, Raynard, B. Nutritional support of the cancer patient: issues and dilemmas. Crit Rev Oncol/Hematol 2000; 34 (3): 137–168.10.1016/S1040-8428(00)00048-2CrossRefGoogle ScholarPubMed
Ravasco, P, Monteiro-Grillo, I, Camilo, ME. Does nutrition influence quality of life in cancer patients undergoing radiotherapy? Radiother Oncol 2003; 67 (2): 213–220.10.1016/S0167-8140(03)00040-9CrossRefGoogle ScholarPubMed
Mura, F, Bertino, G, Occhini, A, Mevio, N, Scelsi, D, Benazzo, M. Advanced carcinoma of the hypopharynx: functional results after circumferential pharyngolaryngectomy with flap reconstruction. Acta Otorhinolaryngol Ital 2012; 32 (3): 154–157.Google ScholarPubMed
Lowe, AS, Laasch, HU, Stephenson, S, et al. Multicentre survey of radiologically inserted gastrostomy feeding tube (RIG) in the UK. Clin Radiol 2012; 67 (9): 843–854.10.1016/j.crad.2012.01.014CrossRefGoogle Scholar
Bhatti, AB, Rizvi, FH, Waheed, A, et al. Does prior percutaneous endoscopic gastrostomy alter post-operative outcome after esophagectomy. World J Surg 2015; 39 (2): 441–445.10.1007/s00268-014-2812-8CrossRefGoogle ScholarPubMed
Brotherton, A, Abbott, J, Aggett, P. The impact of percutaneous endoscopic gastrostomy feeding upon daily life in adults. J Hum Nutr Diet 2006; 19 (5): 355–367.10.1111/j.1365-277X.2006.00712.xCrossRefGoogle ScholarPubMed
Starr, B, Davis, S, Ayala-Peacock, D, Blackstock, WA, Levine, EA. Reassessment of the role of enteral tube feedings for patients with esophageal cancer. Am Surg 2014; 80 (8): 752–758.Google ScholarPubMed
Sarper, A, Oz, N, Cihangir, C, Demircan, A, Isin, E. The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas. Eur J Cardio-Thorac Surg 2003; 23 (5): 794–798.10.1016/S1010-7940(03)00091-5CrossRefGoogle ScholarPubMed
Song, HY, Lee, DH, Seo, TS, et al. Retrievable covered nitinol stents: experiences in 108 patients with malignant esophageal strictures. J Vasc Interv Radiol 2002; 13 (3): 285–293.10.1016/S1051-0443(07)61722-9CrossRefGoogle ScholarPubMed
Jones, CM, Griffiths, EA. Safety implications of oesophageal stents used for the palliation of dysphagia in patients undergoing neoadjuvant therapy for oesophageal malignancy. J Gastrointest Oncol 2014; 5 (4): E54–E55.Google ScholarPubMed
Abu Dayyeh, BK, Vandamme, JJ, Miller, RC, Baron, TH. Esophageal self-expandable stent material and mesh grid density are the major determining factors of external beam radiation dose perturbation: results from a phantom model. Endoscopy 2013; 45 (1): 42–47.Google ScholarPubMed
Li, XA, Chibani, O, Greenwald, B, Suntharalingam, M. Radiotherapy dose perturbation of metallic esophageal stents. Int J Radiat Oncol Biol Phys 2002; 54 (4): 1276–1285.10.1016/S0360-3016(02)03803-8CrossRefGoogle ScholarPubMed
Mullan, D, O’Dwyer, S, Laasch, HU. Benign anastomotic stricture of the rectum complicated by metal stent insertion: salvage by placement of a biodegradable polydioxanone stent. Gastrointest Interv 2013; 2: 59–61.10.1016/j.gii.2013.01.001CrossRefGoogle Scholar
Stivaros, SM, Williams, LR, Senger, C, Wilbraham, L, Laasch, HU. Woven polydioxanone biodegradable stents: a new treatment option for benign and malignant oesophageal strictures. Eur Radiol 2010; 20 (5): 1069–1072.10.1007/s00330-009-1662-5CrossRefGoogle ScholarPubMed
Repici, A, Vleggaar, FP, Hassan, C, et al. Efficacy and safety of biodegradable stents for refractory benign esophageal strictures: the BEST (Biodegradable Esophageal Stent) study. Gastrointestinal Endosc 2010; 72 (5): 927–934.10.1016/j.gie.2010.07.031CrossRefGoogle ScholarPubMed
Petrtyl, J, Bruha, R, Horak, L, Zadorova, Z, Dosedel, J, Laasch, HU. Management of benign intrahepatic bile duct strictures: initial experience with polydioxanone biodegradable stents. Endoscopy 2010; 42 (Suppl 2): E89–E90.10.1055/s-0029-1243880CrossRefGoogle ScholarPubMed
Cerna, M, Kocher, M, Valek, V, et al. Covered biodegradable stent: new therapeutic option for the management of esophageal perforation or anastomotic leak. Cardiovascd Interv Radiol 2011; 34 (6): 1267–1271.10.1007/s00270-010-0059-9CrossRefGoogle ScholarPubMed
van Boeckel, PG, Vleggaar, FP, Siersema, PD. A comparison of temporary self-expanding plastic and biodegradable stents for refractory benign esophageal strictures. Clin Gastroenterol Hepatol 2011; 9 (8): 653–659.10.1016/j.cgh.2011.04.006CrossRefGoogle ScholarPubMed
Griffiths, EA, Gregory, CJ, Pursnani, KG, Ward, JB, Stockwell, RC. The use of biodegradable (SX-ELLA) oesophageal stents to treat dysphagia due to benign and malignant oesophageal disease. Surg Endosc 2012; 26 (8): 2367–2375.10.1007/s00464-012-2192-9CrossRefGoogle ScholarPubMed
Tessier, W, Piessen, G, Briez, N, Boschetto, A, Sergent, G, Mariette, C. Percutaneous radiological gastrostomy in esophageal cancer patients: a feasible and safe access for nutritional support during multimodal therapy. Surg Endosc 2013; 27 (2): 633–641.10.1007/s00464-012-2506-yCrossRefGoogle ScholarPubMed
Javed, A, Pal, S, Dash, NR, et al. Palliative stenting with or without radiotherapy for inoperable esophageal carcinoma: a randomized trial. J Gastrointest Cancer 2012; 43 (1): 63–69.10.1007/s12029-010-9206-4CrossRefGoogle ScholarPubMed
Shenfine, J, McNamee, P, Steen, N, Bond, J, Griffin, SM. A pragmatic randomised controlled trial of the cost-effectiveness of palliative therapies for patients with inoperable oesophageal cancer. Health Technol Assess 2005; 9 (5): iii, 1–121.10.3310/hta9050CrossRefGoogle ScholarPubMed