Failure of self-expanding plastic stents in treatment of refractory benign esophageal strictures

A removable, self-expanding plastic stent (SEPS) has recently been approved in the United States for management of refractory benign esophageal stricture (RBES), but data on its use are quite limited. Five patients with RBES (two anastomotic, one radiation-induced, one caustic, one peptic) underwent placement of a SEPS at our institution. All five patients developed complications related to SEPS placement. Three patients had distal stent migration, one patient had localized esophageal perforation at the proximal margin of the stent and, following stent placement, one patient developed severe chest pain associated with ulceration at the proximal stent margin. While placement of a removable SEPS is a conceptually attractive option for management of RBES, our initial results reveal a high rate of short-term complications. Modifications in stent design may prevent complications and allow adequate time for stricture remodeling.