Self-Expandable Metallic Stent Proves Effective for Radiation-Induced Esophageal Narrowing

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FORMOSA NEWS - Surabaya - A medical research team from Universitas Airlangga (UNAIR) in Surabaya has successfully published a clinical breakthrough in treating a severe long-term complication of radiotherapy known as Radiation-Induced Esophageal Stricture (RIES). The clinical report, published in the Asian Journal of Healthcare Analytics (AJHA), Volume 5, 2026, was led by Dr. Annisa Zahra Mufida alongside her colleagues Dr. Amie Vidyani, Dr. Andi Ratna Kartika Maharani, Dr. Amal Arifi Hidayat, and Dr. Titong Sugihartono. This comprehensive case-based study demonstrates that deploying a Fully Covered Self-Expandable Metallic Stent (SEMS) successfully restores swallowing function and dramatically improves patient quality of life after conventional methods repeatedly failed.

Radiotherapy Complications That Threaten Patient Nutrition

Advanced-stage breast cancer treatment often requires an aggressive combination of therapies, including surgery, chemotherapy, and thoracic radiotherapy. Although radiation therapy is crucial to destroy remaining cancer cells, exposing the thoracic or cervical region to high-dose radiation carries a significant risk of injuring adjacent healthy tissues. One of the most challenging long-term side effects is chronic inflammation and subsequent fibrosis of the esophageal wall.

This fibrotic process leads to an abnormal narrowing of the esophageal lumen, medically termed RIES. The stricture typically develops progressively within six months after completing radiotherapy. Statistically, the risk of developing these strictures remains under 2% for radiation doses below 50 Gy, but jumps sharply to approximately 15% when patients receive a radiation dose of 60 Gy.

"This severe narrowing of the food pipe due to radiation causes progressive difficulty in swallowing, or dysphagia, which severely impacts the patient's daily life," Dr. Annisa Zahra Mufida noted in the clinical report. "The swallowing impairment generally begins with solid foods and gradually worsens to the point where patients cannot tolerate semi-solids or even liquids." This condition directly leads to a drastic reduction in nutritional intake and a severe decline in overall quality of life.

The Limitations of Conventional Methods: A Case Chronology

In standard medical practice, the primary first-line treatment for managing esophageal strictures is endoscopic balloon dilation (such as Controlled Radial Expansion balloon dilation) or bougie medical dilators. However, in strictures caused by radiation therapy, the resulting scar tissue is uniquely rigid, dense, and highly elastic, causing exceptionally high recurrence rates after standard balloon dilation procedures.

The study by Universitas Airlangga meticulously documents the clinical timeline of a 47-year-old female patient diagnosed with stage IV breast carcinoma that had metastasized to her liver. Her medical background included a modified radical mastectomy (MRM) followed by 36 sessions of intensive radiotherapy completed two years prior. The patient presented at the hospital with progressive dysphagia over three months, reaching a state where she could only tolerate milk and soft foods, leaving her severely malnourished.

The team of specialists at UNAIR performed a thorough evaluation using an upper gastrointestinal endoscopy (Esophagogastroduodenoscopy / EGD). The endoscopic evaluation revealed a 4 cm long esophageal stricture located exactly 25–30 cm from the patient's incisors. The clinical management progressed through several crucial steps:

1. First Balloon Dilation: The initial dilation successfully opened the esophageal passage and temporarily restored the patient's swallowing function, allowing her to be discharged. However, within weeks, the stricture aggressively recurred.
2. Second Dilation and Steroid Injection: The medical team conducted a second EGD and applied a combination of pneumatic balloon dilation paired with a direct injection of corticosteroids into the scar tissue (intralesional). This combination therapy was intended to suppress collagen deposition and halt new scar formation. Unfortunately, its efficacy was short-lived, and painful dysphagia quickly returned.
3. Secondary Complications: Due to the persistent obstruction and internal pressure changes, the patient developed acute shortness of breath and was diagnosed with a tension fluid pneumothorax (a dangerous accumulation of air and fluid in the chest cavity), which required immediate emergency chest tube insertion.

Efikasi of Self-Expandable Metallic Stents (SEMS) as the Ultimate Solution

Faced with this stubborn, refractory stricture, the multidisciplinary medical team at Universitas Airlangga made the critical decision to transition to advanced interventional technology: the placement of a self-expandable metallic stent (SEMS). The delicate procedure was executed in the operating room under real-time fluoroscopic (X-ray) guidance to guarantee absolute precision in placement.

A Wallflex fully covered SEMS, measuring 23 mm in diameter and 125 mm in length, was successfully deployed across the narrowed 4 cm segment of the esophagus. The primary mechanism of a SEMS is to exert a constant, continuous radial force outward against the esophageal walls. This sustained pressure remodels the fibrotic tissue from within, keeping the esophageal lumen open over the long term.

The post-procedural outcomes were highly successful. The stent expanded perfectly in its intended position without causing any organ tears or immediate complications. Immediately following the SEMS placement, the patient's ability to swallow was fully restored, allowing her to resume a normal oral diet, improve her nutritional status, and completely eliminate the need for high-risk, repetitive balloon dilations.

Clinical Implications and Health Policy Benefits

This case study carries significant implications for the global medical community and healthcare policy frameworks. The publication by UNAIR academics highlights that utilizing a fully covered SEMS should be considered much earlier in the therapeutic strategy for radiation-induced esophageal strictures when initial balloon dilations fail to deliver durable outcomes.

The choice of a fully covered metallic stent is technically superior to plastic or partially covered variants in benign cases. Its specialized protective coating effectively prevents tissue ingrowth into the inner stent channel while allowing the medical team to easily remove or adjust the device in the future if required. Nevertheless, the researchers emphasize that close clinical follow-up and personalized patient monitoring remain vital to minimize potential secondary risks, such as stent migration or localized chest discomfort.

Research Team Profile

Dr. Annisa Zahra Mufida Affiliation: Medical Staff and Clinical Researcher at the Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. Area of Expertise: Gastroenterology, Hepatology, and Interventional Endoscopy for complex gastrointestinal disorders.

Co-Researchers (Universitas Airlangga): Dr. Amie Vidyani, Dr. Andi Ratna Kartika Maharani, Dr. Amal Arifi Hidayat, and Dr. Titong Sugihartono. This research group is actively engaged in developing evidence-based clinical innovations within gastroenterology and healthcare analytics.

Official Research Reference

Article Title: Self-Expandable Metallic Stent Placement for Radiation-Induced Esophageal Stricture: A Case Report

Journal Name: Asian Journal of Healthcare Analytics (AJHA)
Publication Year: 2026
Official DOI: https://doi.org/10.55927/ajha.v5i1.15847

https://journal.formosapublisher.org/index.php/ajha