A novel stent, called Universal Partially Covered Removable Self-expanding Stent and Anchoring System for the Treatment of Refractory Benign Esophageal Strictures (UAS-RBS) was designed to improve the treatment of benign esophageal refractory strictures with a novel stent. This study aims at evaluating the safety of this new device.
Refractory strictures are defined as benign esophageal strictures who do not achieve acceptable symptom relief despite an intensive dilation schedule. Considering the failure of balloon or mechanical dilation other techniques such as intralesional injection of corticosteroids or stents placement were developed. Self-expandable metal stents, plastic stents and biodegradable stents are also used in that indication. In a meta-analysis of 18 studies with 444 patients, clinical success was achieved in 41 percent of patients. Stent migration occurred in 29 percent of patients, and adverse events occurred in 21 percent. A self-expending nitinol stent has been design to reduce the migration risk. The stent is partially covered on both extremities, allowing the formation of small hyperplasia in the middle part of the stent. This design with the inner sheet (usually, when using fully covered stents, the sheet is outside) allows formation of hyperplasia (therefore reducing the risk of migration) but partly controlled by the inner sheet to reduce the risk of lumen occlusion. By this design, the balance between hyperplasia formation to avoid the risk of migration and reducing the risk of lumen occlusion could be entailed stable esophageal calibration. The UAS-RBS system is a reversible procedure to treat Refractory Benign Esophageal Strictures through stent implantation. Above standard of care monitoring, safety assessment of the procedure and device performance decreases the risk and unforeseen events.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
11
An upper endoscopy will be performed with the use of fluoroscopy. Depending on the size of the stricture a dilation can be performed prior to the stent deployment. Otherwise, the stent will be deployed over a guidewire, under fluoroscopy. After, the gastroscopy will go through the esophagus to check for the stent deployment, or any complications. An injection of contrast agent will be done to be sure of the correct positioning and that no complications was happened. The patient will be kept overnight, with liquid food for 3 days and under PPI until one month after the stent placement.
Six months after implantation, the removal of the stent will be performed. Patient will undergo a first endoscopy under general anesthesia for the placement of a FCSEMS. Then, depending on the importance of the hyperplasia, removal of both stents, under general anesthesia, will be done after 7 to 10 days.
CUB Hopital erasme
Anderlecht, Belgium
Incidence of all Adverse Device Effects
Serious adverse event (SAE) during the period of stent implantation
Time frame: 6 months
Technical stent placement success
Ability to deploy the UAS-RBS in satisfactory position across the stricture
Time frame: Day 0
Full deployment of stent
Endoscopic visualization
Time frame: Day 0
Technical stent removal success
Ability to remove the stent without complications
Time frame: up to 6 months
SAE during the period after stent removal
Time frame: 6 months post retrieval
Number of re-interventions
Time frame: within 12 months following stent placement
Change of dysphagia score (Dakkak and Bennett score of Dysphagia)
Time frame: Baseline and at week 1, month 1, 2, 3, 6, 9, 12 after implantation
Patient's satisfaction with the therapy
scored by a visual analog scale (0 worse - 10 best)
Time frame: week 1, month 1, 2, 3, 6, 9, 12 after implantation
Patient's report of pain
scored by a visual analog scale (0 worse - 10 best)
Time frame: before treatment, and at week 1, month 1, 2, 3, 6, 9, 12 after implantation
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Quality Of Life SF36 questionnaire
SF36
Time frame: before treatment, and at week 1, month 1, 2, 3, 6, 9, 12 after implantation