Early Stenting Doesn't Prevent Stricture After Barrett's Excision
Based on the data, stenting is not appropriate in the acute phase after complete excision, senior author Dr. Michael J. Bourke from Westmead Hospital in New South Wales, Australia, told Reuters Health by email.
"Improvements in methods of internal fixation, e.g., full thickness endoscopic suturing, may improve the potential utility of stents for stricture prevention," he said.
Esophageal stricture formation follows 17% to 88% of complete Barrett's excisions, and there is no proven method for preventing post-endoscopic mucosal resection strictures, Dr. Bourke's team writes in Gastrointestinal Endoscopy, online October 15.
The researchers evaluated the effectiveness of temporary stenting in 14 patients with biopsy-proven Barrett's esophagus. They placed 12 stents a median 10 days after CBE, with pre-stent dilation required in seven patients. Stent insertion was technically successful and uncomplicated in all 12 patients. The other two patients were deemed not to require stent insertion.
The team removed the stents after a median 7.5 weeks (range, three to nine weeks). Half of the patients who had stents required esophageal dilation for symptomatic dysphagia after stent removal. These strictures were treated successfully with resolution of dysphagia in all patients.
Three patients required admission for adverse events related to the stent (bronchoesophageal fistula, retrosternal pain, and distal stent migration). Four patients required early stent removal because of pain or dysphagia.
At the time of stent removal, eight patients had ulceration at the proximal end of the stent and four patients had impaction of the distal stent.
"The ideal stent would not migrate and would provide a consistent radial force without causing tissue ulceration or patient discomfort," the investigators say. "Designing a stent to meet these requirements is challenging, particularly in benign conditions."
"If a safe, effective and stricture-free complete excision strategy can be developed, then this has the potential for improved clinical outcomes, including complete histology," Dr. Bourke said. "We have initiated a randomized controlled trial of oral steroids; there is observational data to suggest it works."