Dilation or biodegradable stent placement for recurrent benign esophageal strictures: a randomized controlled trial

Area of Science:

• Gastroenterology
• Endoscopic interventions
• Medical device technology

Background:

• Dilation is the standard treatment for recurrent benign esophageal strictures (BES).
• Biodegradable stents are being explored to potentially improve outcomes and reduce recurrence rates after dilation.
• This study compares the efficacy and safety of early biodegradable stent placement versus traditional dilation for recurrent BES.

Purpose of the Study:

• To compare the efficacy and safety of biodegradable stent placement versus dilation in patients with recurrent benign esophageal strictures.
• To evaluate the number of repeat dilations, time to recurrence, dysphagia, and activity levels over 12 months.

Main Methods:

• A multicenter, randomized study included patients with BES previously treated with dilation (≥16 mm).
• The primary endpoint was the number of repeat endoscopic dilations within 3 and 6 months.
• Secondary outcomes included safety, time to first recurrent dilation, dysphagia, and activity levels over 12 months.

Main Results:

• Biodegradable stent placement resulted in significantly fewer repeat dilations at 3 months (P < 0.001), but groups were similar by 6 months.
• The median time to the first repeat dilation was significantly longer in the biodegradable stent group (106 vs. 41.5 days; P = 0.003).
• Adverse events were similar between groups; two deaths in the stent group were not attributed to the stent. Dysphagia improved, and activity levels were higher in the stent group.

Conclusions:

• Biodegradable stent placement offers a temporary reduction in repeat dilations and a longer interval before recurrent dysphagia compared to dilation alone.
• The exact role of biodegradable stents in managing recurrent benign esophageal strictures requires further investigation.
• Early integration of biodegradable stents may be beneficial for select patients with recurrent BES.