Published online Jul 7, 2019. doi: 10.3748/wjg.v25.i25.3207
Peer-review started: March 7, 2019
First decision: April 8, 2019
Revised: May 14, 2019
Accepted: June 7, 2019
Article in press: June 8, 2019
Published online: July 7, 2019
Stent insertion can effective alleviate the symptoms of benign esophageal strictures (BES). Magnesium alloy stents are a good candidate because of biological safety, but show a poor corrosion resistance and a quick loss of mechanical support in vivo.
To test the therapeutic and adverse effects of a silicone-covered magnesium alloy biodegradable esophageal stent.
Fifteen rabbits underwent silicone-covered biodegradable magnesium stent insertion into the benign esophageal stricture under fluoroscopic guidance (stent group). The wall reconstruction and tissue reaction of stenotic esophagus in the stent group were compared with those of six esophageal stricture models (control group). Esophagography was performed at 1, 2, and 3 weeks. Four, six, and five rabbits in the stent group and two rabbits in the control groups were euthanized, respectively, at each time point for histological examination.
All stent insertions were well tolerated. The esophageal diameters at immediately, 1, 2 and 3 wk were 9.8 ± 0.3 mm, 9.7 ± 0.7 mm, 9.4 ± 0.8 mm, and 9.2 ± 0.5 mm, respectively (vs 4.9 ± 0.3 mm before stent insertion; P < 0.05). Magnesium stents migrated in eight rabbits [one at 1 wk (1/15), three at 2 wk (3/11), and four at 3 wk (4/5)]. Esophageal wall remodeling (thinner epithelial and smooth muscle layers) was found significantly thinner in the stent group than in the control group (P < 0.05). Esophageal injury and collagen deposition following stent insertion were similar and did not differ compared to rabbits with esophageal stricture and normal rabbits (P > 0.05).
Esophageal silicone-covered biodegradable magnesium stent insertion is feasible for BES without causing severe injury or tissue reaction. Our study suggests that insertion of silicone-covered magnesium esophageal stent is a promising approach for treating BES.
Core tip: Stent insertion can be a safe, easy, and effective way to alleviate the symptoms of benign esophageal strictures (BES). However, metallic stent implantation is associated with some severe complications, such as migration, tissue ingrowth, and in-stent restenosis. Biodegradable stent has been used as an effective and accepted method to treat BES. We fabricated a silicone-covered biodegradable magnesium stent, and evaluated technical feasibility, tissue reaction, and stent degradation for treating benign esophageal stricture in a rabbit model. We found that implantation of silicone-covered magnesium stent provided reliable support for at least two weeks, suggesting that it is a promising strategy to treat benign esophageal stricture.