A modified self-expanding Niti-S stent for the management of benign hypopharyngeal strictures

Background: The management of patients with refractory hypopharyngeal strictures after surgery in combination with radiation therapy is disappointing, and nutrition through feeding tubes is often required. Objective: To evaluate the efficacy and safety of a modified self-expanding Niti-S metal stent in the treatment of hypopharyngeal strictures after combined therapy for laryngeal cancer. Design: Case series. Setting: A general hospital and a university hospital. Patients: Seven consecutive patients were included. One of them did not have laryngectomy. Interventions: All patients received a modified Niti-S stent. Main Outcome Measurements: Improvement of dysphagia, avoiding periodic bougienage, and enteral nutrition through feeding tubes. Results: After placement of the first stent, dysphagia improved in all patients. Six of 7 patients developed stent migration and/or granulomatous tissue ingrowth or overgrowth. Additional stents were placed in all patients after a median of 3 months after the previous stent placement. One patient developed an esophagorespiratory fistula caused by a Polyflex stent. Two patients died of causes unrelated to the stent. The remaining 5 patients remained alive and asymptomatic after a median follow-up of 10 months. Limitations: Periodic stent exchange. Stent placement did not resolve the stricture definitively. We had a limited number of patients and have no long-term outcome data yet. Conclusions: The use of this modified Niti-S stent avoids both enteral nutrition through feeding tubes and the need for periodic bougienage in patients with difficult-to-treat benign hypopharyngeal strictures.