Published online Dec 28, 2014. doi: 10.3748/wjg.v20.i48.18199
Revised: July 7, 2014
Accepted: September 5, 2014
Published online: December 28, 2014
AIM: To undertake a randomised pilot study comparing biodegradable stents and endoscopic dilatation in patients with strictures.
METHODS: This British multi-site study recruited seventeen symptomatic adult patients with refractory strictures. Patients were randomised using a multicentre, blinded assessor design, comparing a biodegradable stent (BS) with endoscopic dilatation (ED). The primary endpoint was the average dysphagia score during the first 6 mo. Secondary endpoints included repeat endoscopic procedures, quality of life, and adverse events. Secondary analysis included follow-up to 12 mo. Sensitivity analyses explored alternative estimation methods for dysphagia and multiple imputation of missing values. Nonparametric tests were used.
RESULTS: Although both groups improved, the average dysphagia scores for patients receiving stents were higher after 6 mo: BS-ED 1.17 (95%CI: 0.63-1.78) P = 0.029. The finding was robust under different estimation methods. Use of additional endoscopic procedures and quality of life (QALY) estimates were similar for BS and ED patients at 6 and 12 mo. Concomitant use of gastrointestinal prescribed medication was greater in the stent group (BS 5.1, ED 2.0 prescriptions; P < 0.001), as were related adverse events (BS 1.4, ED 0.0 events; P = 0.024). Groups were comparable at baseline and findings were statistically significant but numbers were small due to under-recruitment. The oesophageal tract has somatic sensitivity and the process of the stent dissolving, possibly unevenly, might promote discomfort or reflux.
CONCLUSION: Stenting was associated with greater dysphagia, co-medication and adverse events. Rigorously conducted and adequately powered trials are needed before widespread adoption of this technology.
Core tip: Benign oesophageal strictures are managed by endoscopic dilatation using balloons or bougies, often requiring costly repeat procedures. Biodegradable stents do not usually require removal and may reduce the need for repeated endoscopy. This pilot multi-site randomized study demonstrates that stenting was associated with greater dysphagia, co-medication and adverse events. The oesophageal tract has somatic sensitivity and the process of the stent dissolving, possibly unevenly, might promote discomfort or reflux. Groups were comparable at baseline and findings are statistically significant but patient numbers were small. Rigorously conducted and adequately powered trials are needed before widespread adoption of this technology.