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Polyflex expandable stents in the treatment of esophageal disease: initial experience.

AbstractBACKGROUND:
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.
AuthorsArjun Pennathur, Andrew C Chang, Kevin M McGrath, Gregory Steiner, Miguel Alvelo-Rivera, Omar Awais, William E Gooding, Neil A Christie, Sebastien Gilbert, Rodney J Landreneau, James D Luketich
JournalThe Annals of thoracic surgery (Ann Thorac Surg) Vol. 85 Issue 6 Pg. 1968-72; discussion 1973 (Jun 2008) ISSN: 1552-6259 [Electronic] Netherlands
PMID18498804 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Silicone Elastomers
  • Polyethylene
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Esophageal Fistula (surgery)
  • Esophageal Neoplasms (surgery)
  • Esophageal Stenosis (surgery)
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Polyethylene
  • Postoperative Complications (etiology)
  • Prosthesis Design
  • Prosthesis Failure
  • Prosthesis Implantation
  • Retrospective Studies
  • Silicone Elastomers
  • Stents
  • Tracheoesophageal Fistula (surgery)
  • Treatment Outcome

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