Optimal radial force and size for palliation in gastroesophageal adenocarcinoma: a comparative analysis of current stent technology

Abstract

Background

The optimal use of esophageal stents for malignant and benign esophageal strictures continues to be plagued with variability in pain tolerance, migration rates, and reflux-related symptoms. The aim of this study was to evaluate the differences in radial force exhibited by a variety of esophageal stents with respect to the patient's esophageal stricture.

Methods

Radial force testing was performed on eight stents manufactured by four different companies using a hydraulic press and a 5000 N force gage. Radial force was measured using three different tests: transverse compression, circumferential compression, and a three-point bending test. Esophageal stricture composition and diameters were measured to assess maximum diameter, length, and proximal esophageal diameter among 15 patients prior to stenting.

Results

There was a statistically significant difference in mean radial force for transverse compression tests at the middle (range 4.25–0.66 newtons/millimeter N/mm) and at the flange (range 3.32–0.48 N/mm). There were also statistical differences in mean radial force for circumferential test (ranged from 1.19 to 10.50 N/mm, p < 0.001) and the three-point bending test (range 0.08–0.28 N/mm, p < 0.001). In an evaluation of esophageal stricture diameters and lengths, the smallest median diameter of the stricture was 10 mm (range 5–16 mm) and the median proximal diameter normal esophagus was 25 mm (range 22–33 mm), which is currently outside of the range of stent diameters.

Conclusions

Tested stents demonstrated significant differences in radial force, which provides further clarification of stent pain and intolerance in certain patients, with either benign or malignant disease. Similarly, current stent diameters do not successfully exclude the proximal esophagus, which can lead to obstructive-type symptoms. Awareness of radial force, esophageal stricture composition, and proximal esophageal diameter must be known and understood for optimal stent tolerance.

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