Esophageal stents, which help patients with esophageal cancer eat and swallow better, have been around for many years. But the technology hadn't advanced in a number of years, so its pitfalls hadn't been rectified. Now, however, that may change, as Cook Medical has introduced the Evolution Controlled Release Esophageal Stent System, which was designed in collaboration with U.S. and European doctors with addressing the technology's drawbacks in mind.

June 9, 2008

2 Min Read
Cook Introduces Esophageal Stent System

These drawbacks sometimes meant the stents could not be delivered properly, or that tumor ingrowth would occur, necessitating repeat procedures.According to Barry Slowey, vice president of global sales and marketing for Cook's endoscopy division, the design improvements include:* Making the shape resemble a dumbbell, rather than a cylinder, and not coating the ends of the stent, to better keep the stent lodged in place. These steps could prevent it from migrating out of the esophagus, which would cut back on procedures to remove wayward devices.* Coating the stent with a silicone instead of polyurethane, which most previous products use. "We found that polyurethane does not do well in a very acidic environment, and these patients often have a lot of acid reflux," says Slowey. "We found the best alternative is silicone, which has been used for years on feeding tubes."* Coating the stent on the inside and outside, instead of just the outside. If the inside of the stent is not coated, food can get stuck in it, which can lead to sepsis.* Developing a completely new delivery mechanism. With existing products, once they were unfurled even a small amount, they could not be repositioned. The Evolution comes with a "pistol-grip type delivery mechanism," says Slowey. "Each time the physician squeezes the `trigger,' the stent, which is 8-15 cm in total length, deploys 8 mm. So you can squeeze, then look at the flow, then squeeze, then look at the flow, so the deployment process is more accurate. We also put a button on the handle that reverses the mechanism, like you see on a drill. Up until it's 50% deployed, you can recoil the stent 8 mm at a time, reposition it, and start deployment again."These advances should not only make the product more comfortable for the patient, but they could save costs through fewer stents wasted because of deployment errors and fewer repeat procedures, Slowey says. Yet, he notes, it is priced similarly to existing stents, so that hospitals won't cite upfront costs as a reason not to switch. "We think this will be a disruptive technology and shake up the market," he says.

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