[size=20px]A four-year old undergoes dilation for an esophageal stricture and has a contained perforation. He is initially treated with a nasogastric tube and antibiotics. Fourteen days later a repeat esophagram shows a persistent leak and a small fluid collection adjacent to the esophagus. A decision is made to place a temporary stent. Which of the following statements is true regarding the use of esophageal stents?

 

A the stent should be removed within one month of placement

 

B stent migration is unlikely

 

C tissue overgrowth will occur within a few days

 

D only one stent may be placed at a time

 

E surveillance esophagoscopy is unnecessary[/size]

D

correct answer

A the stent should be removed within one month of placement

 

Esophageal stents have been used in adults for management of benign and malignant strictures as well as minimize leakage after esophageal perforation. There is smaller but growing experience in children. In children with perforation 40 to 100% have been successfully treated with this method.

 

Stent migration is a problem occurring in 20 to 40% of patients in adult and pediatric series. Surveillance esophagoscopy and serial chest films help monitor the location of the stent.

 

Tissue overgrowth can be a problem but not in the first few weeks. The polyurethane membrane on the stent is made to prevent ingrowth. Anecdotal experience suggests that removing the stent within four weeks minimizes this risk and avoids erosion.