A modified self-expanding Niti-S stent for the management of benign hypopharyngeal strictures.

BACKGROUND

The management of patients with refractory hypopharyngeal strictures after surgery in combination with radiation therapy is disappointing, and nutrition through feeding tubes is often required.

OBJECTIVE

To evaluate the efficacy and safety of a modified self-expanding Niti-S metal stent in the treatment of hypopharyngeal strictures after combined therapy for laryngeal cancer.

DESIGN

Case series.

SETTING

A general hospital and a university hospital.

PATIENTS: Seven consecutive patients were included. One of them did not have laryngectomy.

INTERVENTIONS: All patients received a modified Niti-S stent.

MAIN OUTCOME MEASUREMENTS: Improvement of dysphagia, avoiding periodic bougienage, and enteral nutrition through feeding tubes.

RESULTS

After placement of the first stent, dysphagia improved in all patients. Six of 7 patients developed stent migration and/or granulomatous tissue ingrowth or overgrowth. Additional stents were placed in all patients after a median of 3 months after the previous stent placement. One patient developed an esophagorespiratory fistula caused by a Polyflex stent. Two patients died of causes unrelated to the stent. The remaining 5 patients remained alive and asymptomatic after a median follow-up of 10 months.

LIMITATIONS: Periodic stent exchange. Stent placement did not resolve the stricture definitively. We had a limited number of patients and have no long-term outcome data yet.

CONCLUSIONS

The use of this modified Niti-S stent avoids both enteral nutrition through feeding tubes and the need for periodic bougienage in patients with difficult-to-treat benign hypopharyngeal strictures.