Antireflux stents

Because of changing epidemiology, an increasing proportion of esophageal stents must be placed across the gastroesophageal junction (GEJ). However, stents allowing food to pass antegradely in the erect position equally facilitate regurgitation of gastric contents into the esophagus in the supine position. Reported rates of stent-induced reflux vary between 10% and 95%. To address this, a variety of stents have been developed incorporating an antireflux valve. Published evidence of their effectiveness is sparse and inconsistent. Results range from no effect to a nearly 20-fold reduction in patients requiring acid suppression after stenting. On average, valved stents seem at least as effective as additional proton pump inhibitor therapy, with the potential to prevent debilitating regurgitation and aspiration. Stand-alone valves for “retrofitting” are available for patients with severe reflux symptoms from an open stent. Stents placed across the GEJ have a 3 times higher risk of displacement, which is caused by the local anatomy and affects valved and open stents alike. This article reviews the history and current state of antireflux stents.