Plastic and Biodegradable Stents for Complex and Refractory Benign Esophageal Strictures

Endoscopic stent placement is a well-accepted and effective alternative treatment modality for complex and refractory esophageal strictures. Among the currently available types of stents, the partially covered self-expanding metal stent (SEMS) has a firm anchoring effect, preventing stent migration and ensuring effective covering of a narrowed segment. However, hyperplastic tissue reaction driven by the uncovered mesh may prevent easy and safe stent removal. As an alternative, a fully covered SEMS decreases the recurrence of dysphagia caused by hyperplastic tissue ingrowth; however, it has a high migration rate. Likewise, although a self-expanding plastic stent (SEPS) reduces reactive hyperplasia, the long-term outcome is disappointing because of the high rate of stent migration. A biodegradable stent has the main benefit of not requiring stent removal in comparison with SEMS and SEPS. However, it still has a somewhat high rate of hyperplastic reaction, and the long-term outcome does not satisfy expectations. Up to now, the question of which type of stent should be recommended for the effective treatment of complex and refractory benign strictures has no clear answer. Therefore, the selection of stent type for endoscopic treatment should be individualized, taking into consideration the endoscopist's experience as well as patient and stricture characteristics.

Variant Angina Associated with Migrating Spontaneous Occlulsive Vasospasm of Right Coronary Artery / 고신대학교의과대학학술지

Variant angina is a syndrome of cyclical chest pain at rest caused by vasospasm and associated with ST-segment elevation. Most of these cases are induced by the provocation with ergonovine or acetylcholine, and mechanical irritation of coronary artery by catheter, but spontaneous migrating spasm in right coronary artery is very rare. We report a fifty one year old male patient presenting as a variant angina due to spontaneous migrating spasm in right coronary artery during diagnostic coronary angiogram. The spasm was relieved spontaneously or by the administration of intracoronary nitroglycerin. No chest pain was documented after medication with calcium-channel blocker and nitrates on 6 month clinical follow-up. This paper presents our experience with a patient presenting with migrating coronay vasospasm of right coronary artery.