Oesophageal stents are used for strictures (narrowing) of the oesophagus. Strictures may be benign or malignant (cancerous).At the London Gastroenterology Centre, we are able to offer a full range of endoscopic diagnostic and therapeutic interventions.
There are essentially three types of oesophageal stent available on the market at the moment:
Metal oesophageal stents are usually made of a chicken wire-like mesh and may be either uncovered or covered with a thin see-through plastic material. This covering may either cover the entire length of the stent or only the middle portion of it. The inner diameter of the stent is usually around 18-20mm but it is often flared at the top and bottom ends to prevent movement of the stent.
These stents are used in cancers where there is no plan to remove them later on. If a person has already had primary treatment such as surgery and develops recurrent cancer or is not having surgery and has a stent as primary treatment it is very unlikely that the stent will be removed at a later stage. In this situation one wants to make sure the stent stays in the right position and does not migrate. At the same time one does not want the tumour to grow through the stent wall. For this reason the tumour area is covered by the plastic coated part of the metal stent. The top and bottom ends of the stent, however, remain uncovered. This allows normal tissue to grow through and to embed the stent properly in the oesophagus.
These stents may also be used in cancer but have a higher rate of migration – which means that the stent falls out of the oesophagus and into the stomach. This risk is about 15-20%. In this situation the original problem with difficulty swallowing will return.
The advantage of fully-covered metal stents, however, is that they are easily repositionable and can be removed in the first few months after they are placed. This may be particularly useful in people with short-term difficulty swallowing.
This is a completely new type of stent, which is based on the same material that is used for dissolvable sutures in surgery. The stent only stays in position until it is degraded by the body. This is usually around three months. At the end of this time, there is no stent left. It is simply reabsorbed. This is particularly useful for people with benign strictures which are expected to heal over that time.
Oesophageal stents are most frequently used in patients with oesophageal cancer, but are increasingly used in people with benign strictures who have not responded to repeat dilatations. Their use must be carefully supervised in order to make sure the right people get the right treatments. This is a complex area and needs specialist input. It is important to have a doctor who looks after this sort of problem frequently in order to ensure the right choice is made.
After an oesophageal stent is put in most people will have some discomfort or pain in the chest or back for up to 72 hours. In the majority of them this disappears, but in approximately one in 10 people there can be long-lasting discomfort, which may require regular painkillers.
After a stent is put in a person can expect to be able to eat pureed food and some solids. We advise, however, not to try taking solid lumps of meat, bread or even porridge as these can get stuck within the stent. If food does get stuck in the stent this requires endoscopy to remove the blockage.
Stent insertion is done during standard endoscopy test under x-ray screening. The procedure usually takes 30 to 45 minutes. Patients may stay in hospital overnight to ensure that their swallowing is improving, particularly as it can take one or two days for stents to open completely. During this time there may be some discomfort and the swallowing may not yet have returned to an acceptable state. This has to be judged on a case-by-case basis and it is always best to have an expert gastroenterologist looking after the patient.