A degradable esophageal stent in the treatment of a corrosive esophageal stenosis in a child

A 10-year-old boy accidentally ingested drain cleaner (15 % NaOH solution; pH 12.5) from a bottle. He vomited and developed dysphagia and retrosternal pain. Endoscopy showed major circumferential ulcerations (grade IIb) [1]. Follow-up endoscopy after 4 weeks showed a stenosis at the mid esophagus, allowing passage of a neonatal endoscope (diameter 4.9 mm). A self-expandable, biodegradable SX-Ella esophageal stent (diameter 25 mm, length 80 mm; Ella-CS, s. r. o., Hradec Králové, Czech Republic) was inserted 6 weeks after the ingestion with the patient under anesthesia ([Fig. 1]). Retrosternal pain, dysphagia, and nausea occurred for a few days. About 10 days later, the boy became asymptomatic. During all this time, oral omeprazole (20 mg/day) was given. Further follow-up endoscopy after 3 weeks showed that the distal end of the stent had extended into the stomach ([Fig. 2]). About 12 weeks after insertion, the stent was 50 % degraded. At that time, the esophageal mucosa had healed. Although the patient remained symptom-free for 4 months, he developed a severe distal esophageal stenosis over 4 cm about 10 months after the initial ingestion and 6 months after the stent placement.

Fig. 1 View of the stent immediately after esophageal insertion.

Fig. 2 Retrograde view of the stent protruding into the stomach after 3 weeks.

Strictures typically develop during proliferation of fibroblasts, with deposition of collagen after 1 – 3 months. Stenting, which has been performed for more than 20 years, provides a better outcome than dilation (68 % healing versus 33 %) [2] [3]. Poor patient compliance and gastroesophageal reflux resulting from esophageal shortening during scar formation were the reasons for failure [3]. In another reported series 8 out of 11 patients had a normal feeding pattern, even after stent removal (follow-up 3.5 years) [4]. Self-expanding stents are easily introduced and are removed endoscopically. Common complications of these stents are chest pain, dysphagia, and nausea [5]. Recently, biodegradable stents were developed which maintain their integrity and radial force for 6 – 8 weeks. Disintegration occurs 11 – 12 weeks after insertion. The SX-Ella esophageal degradable BD Stent should be further evaluated as first-choice intervention in patients developing a corrosive esophageal stenosis.

Endoscopy_UCTN_Code_TTT_1AO_2AZ

References

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