Biodegradable stent placement before neoadjuvant chemoradiotherapy as a bridge to surgery in patients with locally advanced esophageal cancer.

Dysphagia is the most common presenting symptom in patients with esophageal malignancy and contributes significantly to weight loss and malnourishment. An increasing number of patients with locally advanced esophageal cancer undergo treatment with neoadjuvant chemoradiotherapy (CRT) before surgery because this has been shown to improve survival. Neoadjuvant CRT is, however, associated with acute inflammation and edema of the esophageal mucosa, which could increase symptoms of dysphagia and potentially further jeopardize nutritional status. There are various options for nutritional support during neoadjuvant CRT, including nasal-enteral tube feeding, laparoscopic jejunostomy, and total parenteral nutrition. None of these options relieves dysphagia. Therefore, based on the good results of self-expandable stent placement in the palliative setting, self-expandable stents were introduced as a bridge to surgery during neoadjuvant treatment. Fully covered, self-expandable, metal and plastic stents (FSEMS and FSEPS) have been used with good results, but this is at the expense of additional endoscopic procedures either to remove amigrated stent or to extract the stent before surgery. In addition, SEMSs may hamper dose planning of radiotherapy because of backscatter on CT. Recently, biodegradable stents have been developed to treat refractory benign esophageal strictures. These