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Ann Thorac Surg 2008;85:1968-1973. doi:10.1016/j.athoracsur.2008.01.095
© 2008 The Society of Thoracic Surgeons
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Arjun Pennathur
Andrew C. Chang
Miguel Alvelo-Rivera
Neil A. Christie
Sebastien Gilbert
Rodney J. Landreneau
James D. Luketich
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Right arrow Esophagus - other

Original Articles: General Thoracic

Polyflex Expandable Stents in the Treatment of Esophageal Disease: Initial Experience

Arjun Pennathur, MDa, Andrew C. Chang, MDb, Kevin M. McGrath, MDc, Gregory Steiner, BSa, Miguel Alvelo-Rivera, MD, FACSa, Omar Awais, DOa, William E. Gooding, MSd, Neil A. Christie, MDa, Sebastien Gilbert, MDa, Rodney J. Landreneau, MDa, James D. Luketich, MDa,*

a Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
b Department of Surgery, University of Michigan, Ann Arbor, Michigan
c Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
d The University of Pittsburgh Cancer Institute Biostatistics Facility, Pittsburgh, Pennsylvania

Accepted for publication January 23, 2008.

* Address correspondence to Dr Luketich, The Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh, Suite C-800, 200 Lothrop Street, Pittsburgh PA 15213 (Email: luketichjd{at}upmc.edu).

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: The new generation of expandable plastic esophageal stents (Polyflex; Boston Scientific, Natick, MA), combine the features of plastic and self-expanding metallic stents. The main objective of this study is to evaluate our initial experience with Polyflex expandable stents in the treatment of esophageal disease from two institutions.

Methods: A total of 58 Polyflex stents were placed in 38 patients over a two-year period. There were 24 men and 14 women, with a median age of 63 years (range, 25 to 83). The most common indication for placement was an esophageal stricture in 25 patients (66%); other causes included leak in 8 (21%) and tracheoesophageal fistula (TEF) in 5 (13%). We evaluated the hospital course, complications, and outcomes.

Results: The median postoperative stay was one day. Complications included migration in 38 stents (63%) (28 patients; 73%), retrosternal chest discomfort in nine, reflux in four, airway obstruction in one, and food impaction in three. Continued leak or a persistent TEF occurred in five patients (38%). Reintervention was required predominantly due to migration of the stent at a mean interval of 46 days (range, 1 to 353). Patients with dysphagia improved significantly with dysphagia scores (1 = no dysphagia; 5 = unable to swallow saliva) improving from 3.44 to 2.15 (p < 0.0001).

Conclusions: Polyflex stents were effective in the relief of dysphagia due to strictures. They were less effective in esophageal perforations or leaks. Their primary disadvantage is a high migration rate and further improvements in design are required to decrease this high incidence of migration.




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