A41 OUTCOMES FROM ESOPHAGEAL STENT PLACEMENT FOR REFRACTORY BENIGN ESOPHAGEAL STRICTURES
Bibliographic record
Abstract
Abstract Background A benign esophageal stricture (BES) is an esophageal narrowing that causes dysphagia in the absence of inflammation. First-line treatment for BES is esophageal bougie or balloon dilation. Esophageal stent placement is a treatment option for refractory benign esophageal strictures (RBES) but comes with significant complication risks. Aims We aim to assess complications following esophageal stent placement for RBES and whether there are differences in migration rates depending on the stent length, stent width, and presence of clip or suture fixation. Methods This is a retrospective cohort study of adult patients with RBES who were treated with esophageal stent placement at the Vancouver General Hospital, Vancouver, Canada between Jan. 1st, 2016 and Aug. 20th, 2024. We excluded patients with malignant esophageal strictures and esophageal leakages. Data was manually extracted via patient chart review. Results 12 patients received a total of 32 esophageal stents for RBES. 50.0% of patients had peptic strictures. 33.3% of patients had anastomotic strictures post-esophagectomy. Other causes included Barrett’s esophagus and brachytherapy. Patients received on average 7 dilations before their first stent placement. Average stent indwell time was 157 days. All stents were fully covered and metal. The average number of stents placed was 3. The average number of adverse events was 4. 87.5% of stents led to adverse events. 53.1% (17 of 32 stents) of stents migrated. 12.5% (4 of 32 stents) of stents caused granulation tissue. Stent ingrowth occurred in 6.25% of stents placed (2 of 32 stents). Other adverse events included gastrointestinal bleed, ulcers, food obstruction, dysphagia, odynophagia, chest pain, and abdominal pain. 33.3% of patients required hospitalization from adverse events. No deaths or critical care stays occurred from adverse events. 25.0% of stents were fixed with clips, padlock clips, or sutures. Risk of migration did not statistically differ between fixation and no fixation (50.0% vs 54.2%, p>0.05). Short (less than 12cm) and wide stents (greater than 18mm) were less likely to migrate as compared to long and narrow stents (52.0% vs 57.1%, p<0.05; 42.9% vs 62.5%, p<0.05; respectively). Conclusions Esophageal stent placement is an appropriate treatment for RBES. Although adverse events occurred in most stents placed, most were mild and manageable with appropriate counselling and intervention. No adverse events occurred leading to death or critical care stay. Guidelines from the European Society of Gastrointestinal Endoscopy recommend a maximum indwell time of 12 weeks, but in select circumstances longer indwell times are possible. Funding Agencies:
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".