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Gastrointestinal Tract Stenting

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Diagnostic and Therapeutic Procedures in Gastroenterology

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Enteral stent placement for disorders of the gastrointestinal tract has evolved significantly over the past decade. While the majority of enteral stent placement is still performed for malignant obstruction, advancements in endoscopic technique and device technology have opened the door for the use of enteral stenting for benign disease as well. This chapter focuses on the indications, techniques, and currently available technologies for stent placement in the esophagus, small intestine, and colon.

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References

  • Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol. 2002;97:72–8.

    Article  PubMed  Google Scholar 

  • Alam TA, Baines M, Parker MC. The management of gastric outlet obstruction secondary to inoperable cancer. Surg Endosc. 2003;17:320–3.

    Article  PubMed  CAS  Google Scholar 

  • Baron TH. Minimizing endoscopic complications: endoluminal stents. Gastrointest Endosc Clin N Am. 2007;17:83–104. vii.

    Article  PubMed  Google Scholar 

  • Bartelsman JF et al. Palliation of patients with esophagogastric neoplasms by insertion of a covered expandable modified Gianturco-Z endoprosthesis: experiences in 153 patients. Gastrointest Endosc. 2000;51:134–8.

    Article  PubMed  CAS  Google Scholar 

  • Bethge N, Sommer A, Vakil N. Palliation of malignant esophageal obstruction due to intrinsic and extrinsic lesions with expandable metal stents. Am J Gastroenterol. 1998;93:1829–32.

    Article  PubMed  CAS  Google Scholar 

  • Chopita N, Landoni N, Ross A, Villaverde A. Malignant gastroenteric obstruction: therapeutic options. Gastrointest Endosc Clin N Am. 2007;17:533–44. vi-vii.

    Article  PubMed  Google Scholar 

  • Christie NA et al. Results of expandable metal stents for malignant esophageal obstruction in 100 patients: short-term and long-term follow-up. Ann Thorac Surg. 2001;71:1797–801. discussion 1801–2.

    Article  PubMed  CAS  Google Scholar 

  • Conigliaro R et al. Polyflex stents for malignant oesophageal and oesophagogastric stricture: a prospective, multicentric study. Eur J Gastroenterol Hepatol. 2007;19:195–203.

    Article  PubMed  Google Scholar 

  • Conio M et al. A randomized prospective comparison of self-expandable plastic stents and partially covered self-expandable metal stents in the palliation of malignant esophageal dysphagia. Am J Gastroenterol. 2007;102:2667–77.

    Article  PubMed  Google Scholar 

  • Cook TA, Dehn TC. Use of covered expandable metal stents in the treatment of oesophageal carcinoma and tracheo-oesophageal fistula. Br J Surg. 1996;83:1417–8.

    Article  PubMed  CAS  Google Scholar 

  • Cordero Jr JA, Moores DW. Self-expanding esophageal metallic stents in the treatment of esophageal obstruction. Am Surg. 2000;66:956–8. discussion 958–9.

    PubMed  Google Scholar 

  • Costamagna G, Marchese M, Iacopini F. Self-expanding stents in oesophageal cancer. Eur J Gastroenterol Hepatol. 2006;18:1177–80.

    Article  PubMed  Google Scholar 

  • Dasgupta A et al. Airway complications of esophageal self-expandable metallic stent. Gastrointest Endosc. 1998;47:532–5.

    Article  PubMed  CAS  Google Scholar 

  • De Olabozal J, Roberts J, Hoeltgen T, Berkelhammer C. Double stenting to prevent airway compression in proximal malignant esophageal strictures. Am J Gastroenterol. 2001;96:2800–1.

    Article  PubMed  Google Scholar 

  • De Palma GD et al. Self-expanding metal stents for palliation of inoperable carcinoma of the esophagus and gastroesophageal junction. Am J Gastroenterol. 1995;90:2140–2.

    PubMed  Google Scholar 

  • De Palma GD et al. Plastic prosthesis versus expandable metal stents for palliation of inoperable esophageal thoracic carcinoma: a controlled prospective study. Gastrointest Endosc. 1996;43:78–82.

    Google Scholar 

  • De Palma GD et al. Impact on the quality of remaining life of treatment with self-expandable metal prostheses in patients with inoperable esophago-cardial cancer. Results of a study of 107 consecutive patients treated with Ultraflex-type prostheses. Minerva Gastroenterol Dietol. 1999;45:95–106.

    PubMed  Google Scholar 

  • Domschke W, Foerster EC, Matek W, Rodl W. Self-expanding mesh stent for esophageal cancer stenosis. Endoscopy. 1990;22:134–6.

    Article  PubMed  CAS  Google Scholar 

  • Dormann A, Meisner S, Verin N, Wenk Lang A. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy. 2004;36:543–50.

    Article  PubMed  CAS  Google Scholar 

  • Dua KS. Stents for palliating malignant dysphagia and fistula: is the paradigm shifting? Gastrointest Endosc. 2007;65:77–81.

    Article  PubMed  Google Scholar 

  • Dumas R et al. Palliative endoscopic treatment of malignant duodenal stenosis by metal prosthesis. Gastroentérol Clin Biol. 2000;24:714–8.

    PubMed  CAS  Google Scholar 

  • Eickhoff A et al. Self-expanding metal stents versus plastic prostheses in the palliation of malignant dysphagia: long-term outcome of 153 consecutive patients. J Clin Gastroenterol. 2005;39:877–85.

    Article  PubMed  CAS  Google Scholar 

  • Elton E. Esophageal cancer. Dis Mon. 2005;51:664–84.

    Article  PubMed  Google Scholar 

  • Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003;349:2241–52.

    Article  PubMed  CAS  Google Scholar 

  • Farivar AS, Vallieres E, Kowdley KV, Wood DE, Mulligan MS. Airway obstruction complicating esophageal stent placement in two post-pneumonectomy patients. Ann Thorac Surg. 2004;78:e22–3.

    Article  PubMed  Google Scholar 

  • Fiori E et al. Palliative management of malignant antro-pyloric strictures. Gastroenterostomy vs. endoscopic stenting. A randomized prospective trial. Anticancer Res. 2004;24:269–71.

    PubMed  Google Scholar 

  • Fiorini AB et al. Expandable metal coil stent for treatment of broncho-esophageal fistula. Gastrointest Endosc. 1995;42:81–3.

    Article  PubMed  CAS  Google Scholar 

  • Fleischer DE, Bull-Henry K. A new coated self-expanding metal stent for malignant esophageal strictures. Gastrointest Endosc. 1992;38:494–6.

    Article  PubMed  CAS  Google Scholar 

  • Forshaw MJ, Sankararajah D, Stewart M, Parker MC. Self-expanding metallic stents in the treatment of benign colorectal disease: indications and outcomes. Colorectal Dis. 2006;8:102–11.

    Article  PubMed  CAS  Google Scholar 

  • Freeman RK, Van Woerkom JM, Ascioti AJ. Esophageal stent placement for the treatment of iatrogenic intrathoracic esophageal perforation. Ann Thorac Surg. 2007a;83:2003–7. discussion 2007–8.

    Article  PubMed  Google Scholar 

  • Freeman RK, Ascioti AJ, Wozniak TC. Postoperative esophageal leak management with the Polyflex esophageal stent. J Thorac Cardiovasc Surg. 2007b;133:333–8.

    Article  PubMed  Google Scholar 

  • Frimberger E. Expanding spiral-a new type of prosthesis for the palliative treatment of malignant esophageal stenoses. Endoscopy. 1983;15 Suppl 1:213–4.

    Article  PubMed  Google Scholar 

  • Ginsberg GG. Palliation of malignant esophageal Dysphagia: would you like plastic or metal? Am J Gastroenterol. 2007;102:2678–9.

    Article  PubMed  Google Scholar 

  • Gupta K, Freeman M. Enteral and colonic self-expanding metallic stents. Rev Gastroenterol Disord. 2008;8:83–97.

    PubMed  Google Scholar 

  • Holm AN, de la Mora Levy JG, Gostout CJ, Topazian MD, Baron TH. Self-expanding plastic stents in treatment of benign esophageal conditions. Gastrointest Endosc. 2008;67:20–5.

    Article  PubMed  Google Scholar 

  • Homs MY et al. Prior radiation and/or chemotherapy has no effect on the outcome of metal stent placement for oesophagogastric carcinoma. Eur J Gastroenterol Hepatol. 2004a;16:163–70.

    Article  PubMed  Google Scholar 

  • Homs MY et al. Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet. 2004b;364:1497–504.

    Article  PubMed  Google Scholar 

  • Hunerbein M, Stroszczynski C, Moesta KT, Schlag PM. Treatment of thoracic anastomotic leaks after esophagectomy with self-expanding plastic stents. Ann Surg. 2004;240:801–7.

    Article  PubMed  Google Scholar 

  • Jeurnink SM et al. Gastrojejunostomy versus stent placement in patients with malignant gastric outlet obstruction: a comparison in 95 patients. J Surg Oncol. 2007;96:389–96.

    Article  PubMed  CAS  Google Scholar 

  • Johnson E et al. Survival and complications after insertion of self-expandable metal stents for malignant oesophageal stenosis. Scand J Gastroenterol. 2006;41:252–6.

    Article  PubMed  Google Scholar 

  • Kauer WK, Stein HJ, Dittler HJ, Siewert JR. Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy. Surg Endosc. 2008;22:50–3.

    Article  PubMed  Google Scholar 

  • Kawasaki R, Sano A, Matsumoto S. Long-term outcomes and complications of metallic stents for malignant esophageal stenoses. Kobe J Med Sci. 2003;49:133–42.

    PubMed  Google Scholar 

  • Kiernan PD, Sheridan MJ, Hettrick V, Vaughan B, Graling P. Thoracic esophageal perforation: one surgeon’s experience. Dis Esophagus. 2006;19:24–30.

    Article  PubMed  CAS  Google Scholar 

  • Kinsman KJ et al. Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy. Gastrointest Endosc. 1996;43:196–203.

    Article  PubMed  CAS  Google Scholar 

  • Kostopoulos PP et al. Are metal stents effective for palliation of malignant dysphagia and fistulas? Dig Liver Dis. 2003;35:275–82.

    Article  PubMed  CAS  Google Scholar 

  • Kotsis L, Zubovits K, Vadasz P. Management of malignant tracheoesophageal fistulas with a cuffed funnel tube. Ann Thorac Surg. 1997;64:355–8.

    Article  PubMed  CAS  Google Scholar 

  • Kozarek R. Making sense out of colonic stents. Gastrointest Endosc. 2008;67:85–7.

    Article  PubMed  Google Scholar 

  • Kozarek RA et al. Use of the 25 mm flanged esophageal Z stent for malignant dysphagia: a prospective multicenter trial. Gastrointest Endosc. 1997;46:156–60.

    Article  PubMed  CAS  Google Scholar 

  • Lam YH et al. Self-expandable metal stents for malignant dysphagia. Aust N Z J Surg. 1999;69:668–71.

    Article  PubMed  CAS  Google Scholar 

  • Langer FB et al. Management of postoperative esophageal leaks with the Polyflex self-expanding covered plastic stent. Ann Thorac Surg. 2005;79:398–403. discussion 404.

    Article  PubMed  Google Scholar 

  • Lowe AS et al. Self-expandable metal stent placement for the palliation of malignant gastroduodenal obstruction: experience in a large, single, UK centre. Clin Radiol. 2007;62:738–44.

    Article  PubMed  CAS  Google Scholar 

  • Maetani I et al. Self-expandable metallic stent placement for palliation in gastric outlet obstructions caused by gastric cancer: a comparison with surgical gastrojejunostomy. J Gastroenterol. 2007;40:932–7.

    Article  Google Scholar 

  • McGrath JP, Browne M, Riordan C, Ravi N, Reynolds JV. Expandable metal stents in the palliation of malignant dysphagia and oesophageal-respiratory fistulae. Ir Med J. 2001;94:270–2.

    PubMed  CAS  Google Scholar 

  • Mehta S et al. Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction. Surg Endosc. 2006;20:239–42.

    Article  PubMed  CAS  Google Scholar 

  • Moores DW, Ilves R. Treatment of esophageal obstruction with covered, self-expanding esophageal Wallstents. Ann Thorac Surg. 1996;62:963–7.

    Article  PubMed  CAS  Google Scholar 

  • Nagy A, Brosseuk D, Hemming A, Scudamore C, Mamazza J. Laparoscopic gastroenterostomy for duodenal obstruction. Am J Surg. 1995;169:539–42.

    Article  PubMed  CAS  Google Scholar 

  • Nassif T et al. Endoscopic palliation of malignant gastric outlet obstruction using self-expandable metallic stents: results of a multicenter study. Endoscopy. 2003;35:483–9.

    Article  PubMed  CAS  Google Scholar 

  • Ng KC et al. Self-expanding metallic stent as a bridge to surgery versus emergency resection for obstructing left-sided colorectal cancer: a case-matched study. J Gastrointest Surg. 2006;10:798–803.

    Article  PubMed  Google Scholar 

  • Papachristou GI, Baron TH. Use of stents in benign and malignant esophageal disease. Rev Gastroenterol Disord. 2007;7:74–88.

    PubMed  Google Scholar 

  • Profili S et al. Effective management of intrathoracic anastomotic leak with covered self-expandable metal stents. Report on three cases. Emerg Radiol. 2008;15:57–60.

    Article  PubMed  Google Scholar 

  • Radecke K, Lang H, Frilling A, Gerken G, Treichel U. Successful sealing of benign esophageal leaks after temporary placement of a self-expanding plastic stent without fluoroscopic guidance. Z Gastroenterol. 2006;44:1031–8.

    Article  PubMed  CAS  Google Scholar 

  • Radiology., B.S.o.I. ROST: Registry if Iesophageal Stenting, first report 2004. (Hanley-on-Thames: Dendrite Clinical Systems, 2004).

    Google Scholar 

  • Raijman I, Lynch P. Coated expandable esophageal stents in the treatment of digestive-respiratory fistulas. Am J Gastroenterol. 1997;92:2188–91.

    PubMed  CAS  Google Scholar 

  • Raijman I et al. Expandable esophageal stents: initial experience with a new nitinol stent. Gastrointest Endosc. 1994;40:614–21.

    Article  PubMed  CAS  Google Scholar 

  • Raijman I, Siddique I, Ajani J, Lynch P. Palliation of malignant dysphagia and fistulae with coated expandable metal stents: experience with 101 patients. Gastrointest Endosc. 1998;48:172–9.

    Article  PubMed  CAS  Google Scholar 

  • Razzaq R, Laasch HU, England R, Marriott A, Martin D. Expandable metal stents for the palliation of ­malignant gastroduodenal obstruction. Cardiovasc Interv Radiol. 2001;24:313–8.

    Article  CAS  Google Scholar 

  • Repici A et al. Temporary placement of an expandable polyester silicone-covered stent for treatment of ­refractory benign esophageal strictures. Gastrointest Endosc. 2004;60:513–9.

    Article  PubMed  Google Scholar 

  • Repici A et al. Stenting of the proximal colon in patients with malignant large bowel obstruction: techniques and outcomes. Gastrointest Endosc. 2007;66:940–4.

    Article  PubMed  Google Scholar 

  • Rhodes M, Nathanson L, Fielding G. Laparoscopic biliary and gastric bypass: a useful adjunct in the treatment of carcinoma of the pancreas. Gut. 1995;36:778–80.

    Article  PubMed  CAS  Google Scholar 

  • Rollhauser C, Fleischer DE. Late migration of a self-expandable metal stent and successful endoscopic management. Gastrointest Endosc. 1999;49:541–4.

    Article  PubMed  CAS  Google Scholar 

  • Schubert D et al. Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc. 2005;61:891–6.

    Article  PubMed  Google Scholar 

  • Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004;99:2051–7.

    Article  PubMed  Google Scholar 

  • Siddiqui AA, Loren D, Dudnick R, Kowalski T. Expandable polyester silicon-covered stent for malignant esophageal strictures before neoadjuvant chemoradiation: a pilot study. Dig Dis Sci. 2007a;52:823–9.

    Article  PubMed  CAS  Google Scholar 

  • Siddiqui A, Khandelwal N, Anthony T, Huerta S. Colonic stent versus surgery for the management of acute malignant colonic obstruction: a decision analysis. Aliment Pharmacol Ther. 2007b;26:1379–86.

    Article  PubMed  CAS  Google Scholar 

  • Siersema PD. New developments in palliative therapy. Best Pract Res Clin Gastroenterol. 2006;20:959–78.

    Article  PubMed  Google Scholar 

  • Siersema PD, Hop WC, Dees J, Tilanus HW, van Blankenstein M. Coated self-expanding metal stents versus latex prostheses for esophagogastric cancer with special reference to prior radiation and chemotherapy: a controlled, prospective study. Gastrointest Endosc. 1998;47:113–20.

    Article  PubMed  CAS  Google Scholar 

  • Siersema PD, Homs MY, Haringsma J, Tilanus HW, Kuipers EJ. Use of large-diameter metallic stents to seal traumatic nonmalignant perforations of the esophagus. Gastrointest Endosc. 2003;58:356–61.

    Article  PubMed  Google Scholar 

  • Singh H, Latosinsky S, Spiegel BM, Targownik LE. The cost-effectiveness of colonic stenting as a bridge to curative surgery in patients with acute left-sided malignant colonic obstruction: a Canadian perspective. Can J Gastroenterol. 2006;20:779–85.

    PubMed  CAS  Google Scholar 

  • Small AJ, Young-Fadok TM, Baron TH. Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases. Surg Endosc. 2008;22:454–62.

    Article  PubMed  CAS  Google Scholar 

  • Song HY et al. Covered, expandable esophageal metallic stent tubes: experiences in 119 patients. Radiology. 1994;193:689–95.

    PubMed  CAS  Google Scholar 

  • Sundelof M et al. Palliative treatment of malignant dysphagia with self-expanding metal stents: a 12-year experience. Scand J Gastroenterol. 2007;42:11–6.

    Article  PubMed  Google Scholar 

  • Suzuki N et al. Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Dis Colon Rectum. 2004;47:1201–7.

    Article  PubMed  Google Scholar 

  • Targownik LE et al. Colonic stent vs. emergency surgery for management of acute left-sided malignant colonic obstruction: a decision analysis. Gastrointest Endosc. 2004;60:865–74.

    Article  PubMed  Google Scholar 

  • Tilney HS et al. Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc. 2007;21:225–33.

    Article  PubMed  CAS  Google Scholar 

  • Toikkanen VJ et al. Expandable metallic stents in the management of malignant oesophageal obstruction. Ann Chir Gynaecol. 2000;89:20–3.

    PubMed  CAS  Google Scholar 

  • Tuebergen D et al. Treatment of thoracic esophageal anastomotic leaks and esophageal perforations with endoluminal stents: efficacy and current limitations. J Gastrointest Surg. 2008;12:1168–76.

    Article  PubMed  Google Scholar 

  • Vakil N et al. A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction. Am J Gastroenterol. 2001;96:1791–6.

    Article  PubMed  CAS  Google Scholar 

  • Verschuur EM et al. A new esophageal stent design (Niti-S stent) for the prevention of migration: a prospective study in 42 patients. Gastrointest Endosc. 2006;63:134–40.

    Article  PubMed  Google Scholar 

  • Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg. 2007;246:24–30.

    Article  PubMed  Google Scholar 

  • Xinopoulos D et al. Palliative treatment of advanced esophageal cancer with metal-covered expandable stents. A cost-effectiveness and quality of life study. J BUON. 2005;10:523–8.

    PubMed  CAS  Google Scholar 

  • Yano F, Mittal SK. Post-operative esophageal leak treated with removable silicone-covered polyester stent. Dis Esophagus. 2007;20:535–7.

    Article  PubMed  CAS  Google Scholar 

  • Yano F, El Sherif A, Filipi CJ, Mittal SK. Use of temporary esophageal stent in management of perforations after benign esophageal surgery. Surg Laparosc Endosc Percutan Tech. 2008;18:283–5.

    Article  PubMed  Google Scholar 

  • Zwischenberger JB, Savage C, Bidani A. Surgical aspects of esophageal disease: perforation and caustic injury. Am J Respir Crit Care Med. 2002;165:1037–40.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA

    Andrew S. Ross M.D.

  2. Digestive Disease Institute, Virginia Mason Medical Center, Clinical Professor of Medicine, University of Washington, Seattle, WA, USA

    Richard A. Kozarek M.D.

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  1. Andrew S. Ross M.D.
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Correspondence to Richard A. Kozarek M.D. .

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Editors and Affiliations

  1. University of Connecticut School of Medi, Farmington Ave. 236, Farmington, 06030-1845, Connecticut, USA

    George Y. Wu

  2. , Department of Gastroenterology, Medical College of Georgia, Fifteenth St. BBR-2544, Augusta, 30912, Georgia, USA

    Subbaramiah Sridhar

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Ross, A.S., Kozarek, R.A. (2011). Gastrointestinal Tract Stenting. In: Wu, G., Sridhar, S. (eds) Diagnostic and Therapeutic Procedures in Gastroenterology. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59745-044-7_3

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