# Biodegradable and self-expanding metal stents in the treatment of children with strictures after esophageal atresia repair

## TL;DR

This study compares biodegradable and metal stents in children with esophageal strictures, finding biodegradable stents may reduce relapse and complications.

## Contribution

The study introduces biodegradable stents as a novel treatment option for pediatric esophageal strictures with potentially fewer complications.

## Key findings

- Biodegradable stents showed a 64% lower relapse risk compared to metal stents.
- Biodegradable stents had fewer migration complications than metal stents.
- Stenting provided medium-term esophageal patency with minor complications.

## Abstract

This study compared the efficacy and complications of biodegradable stents (BDS) versus self-expandable fully covered metal stents (SEMS) in pediatric patients with strictures after esophageal atresia repair.

The charts of children with esophageal atresia (EA) undergoing stent treatment for anastomotic stricture were retrospectively reviewed. Primary outcomes included time to reintervention (TTR) and procedural success, defined as no necessity of further intervention with a patent esophageal lumen at the time of follow-up. Secondary outcomes included stent-related complications.

From November 2016 to March 2024, a total of 22 BDS and 26 SEMS were placed in 15 patients for strictures. Median TTR was 77 days for BDS vs. 49 days for SEMS. BDS-treated patients had a 64% lower relapse risk (HR: 0.36, CI: 0.19–0.7, p < 0.003). At the end of individual follow-up (median: 6 months), exclusive stenting succeeded in 4 patients, stenting with other minimally invasive procedures in 2, and with surgery in 2. Migration (18.8%) was more less frequent with BDS compared to SEMS (OR: 0.11, CI: 0.00–0.97, p < 0.028), while there was a trend towards more granulation tissue formation with BDS (OR: 3.48, CI: 0.99–24.2, p = 0.052).

Although relapse occurs frequently in the long term, stenting may offer an alternative to assure esophageal patency in the medium term with only few and minor associated complications, notably stent migration and granulation tissue potentially causing restenosis. If placed for recalcitrant stricture, longer periods free of interventions are achieved in comparison to iterative dilatation, particularly when using BDS.