Background: The new generation of a hybrid esophageal stent (Alveolus), combines the features of plastic and self-expanding metallic stents. These stents are utilized for various esophageal benign and malignant diseases. The main objective of this study is to evaluate our initial experience with Alveolus expandable stents in the treatment of esophageal leaks, perforations, or fistulae.
Methods: A total of 19 Alveolus stents were placed in 7 patients for an esophageal perforation, leak from an esophagogastric anastomosis after esophagectomy, and a tracheoesophageal fistula. All 7 patients were men, with a median age of 66 years (range 25-83). The most common indication for placement in this study was for an anastomotic leak in 5 patients (72%). They were placed for perforation in 1 patients (14%); and for a tracheoesophageal fistula in 1 patient (14%). The primary location for stent placement was in the distal esophagus in 5 patients (72%) while the remaining 2 patients had placement of the stent in the proximal esophagus. We evaluated the hospital course, complications, and outcomes.
Results: The median stay was 26 days (range of 0-100). Complications included migration in 3 patients(42%), recurrent fistula in 1 patient , and a disruption in the esophagogastric anastomosis in 1. Reintervention was required predominantly due to migration of the stent at a mean interval of 37 days days (range 0-150). The stent successfully occluded leak or fistula in a majority of patients (4/7= 57%). A total of 6 patients (85%) also had drainage established as an adjunct to stent placement. In patients with an esophageal leak, two of the five patients (40%) also underwent a thoracoscopic drainage procedure for the leak.
Conclusions: Alveolus Stent is a newly designed stent with potential applications in various esophageal diseases. They are not commonly used for the treatment of esophageal perforations or leaks, however had a reasonable success in this selected group. Their primary disadvantage is a high migration rate and further improvements in design are required to decrease this high incidence of migration.