Self-Expanding Biodegradable Stents for Postoperative Upper Gastrointestinal Issues

Abstract

Background and objectives: Endoscopic stenting is a minimally invasive treatment modality for patients with various gastrointestinal conditions. We evaluated the safety and efficacy of uncovered biodegradable stents for postoperative leaks and strictures in the upper gastrointestinal tract.

Methods: This was a retrospective study of patients treated endoscopically with biodegradable stents from January 2010 through November 2017.

Results: Thirteen patients were enrolled, 7 of whom were men. Their mean age was 46 (range, 21-82) years. The indications for stent placement were postoperative leakage and stricture in 9 and 4 patients, respectively. The primary diagnoses were obesity in 7 patients, gastric cancer in 5, and peptic ulcer in 1. The average time to stent placement after surgery was 35 (range, 17-125) and 166 (range, 153-185) days for patients with postoperative leakage and stricture, respectively. Stent insertion was successful at the first attempt in all patients. Complete resolution of the leak and stricture was achieved after stent application in 11 patients, for a clinical success rate of 85%. The mean follow-up duration was 50 (range, 24-76) months. There were no major complications.

Conclusions: Compared to self-expanding metal and plastic stents, the main advantages of uncovered biodegradable stents are that they do not have to be removed and have a low migration rate. Our results suggest that these stents have promise for management of postoperative gastrointestinal complications. Further randomized trials with larger sample sizes are necessary to determine the role of biodegradable stents in the treatment algorithm.

Keywords: Biodegradable stent; Endoscopic stenting; Gastrointestinal complications; Postoperative leaks; Postoperative strictures.

Figure 1.

Endoscopic view of the uncovered bio-degradable stent (on the left). Flouroscopic image of the stent (on the right).