The role of endoluminal stents in gastrointestinal diseases
Introduction
In 1856, Charles Stent developed a thermoplastic material for dental impressions. Little did he know that over 100 years later, his name would be associated with devices to maintain patency of luminal structures throughout the body.
Early attempts at stenting in the 19th century used materials such as ivory and boxwood tubes to stent the esophagus in cases of esophageal carcinoma. Sir Charter Symonds in England used a 6-inch boxwood tube with a silk thread to secure the tube to the patient’s ear to prevent migration.1
Currently, endoluminal stenting is commonly used for palliation in malignant obstruction of the esophagus, gastric outlet and duodenum, biliary tree, and increasingly in colonic obstruction. Technology has progressed from plastic stents used in the esophagus and biliary tree, to metal expandable stents made of expandable metal mesh, which may or may not be covered with a coat of plastic to prevent tumor ingrowth or mucosal hyperplasia through the mesh.
In this article, the use of endoluminal stenting in the esophagus, gastric outlet, and duodenum, colon, and biliary tree is reviewed.
Section snippets
Endoscopic stenting of esophageal obstruction
Approximately 12,000 cases of esophageal carcinoma are diagnosed in the United States each year, with an almost equal number of deaths each year.2 Dysphagia is the most common presentation and complaint in esophageal carcinoma, and may also occur in patients with tumors adjacent to the esophagus, most commonly lung cancer.
Early attempts to palliate dysphagia employed flanged rigid plastic stents placed endoscopically. Currently, these plastic stents have been largely abandoned in favor of
Gastric and duodenal obstruction
Malignant gastric outlet obstruction develops in approximately 10% of patients with pancreatic carcinoma and in patients with gastric, duodenal, colonic, and metastatic cancers. Surgical gastrojejunostomy requires longer hospitalization, higher hospital costs, and, in some series, higher morbidity and mortality than endoluminal stenting.
To date, 2 series of more than 30 patients each, and a number of smaller series have shown metal stenting for gastric outlet obstruction to be very successful
Endoscopic stenting of biliary and pancreatic obstruction
Biliary stenting is used most frequently for the therapy of obstructive jaundice from malignant disease, most commonly pancreatic carcinoma, cholangiocarcinoma, periampullary carcinoma, gallbladder carcinoma, or metastatic tumor. All endoscopic stenting procedures begin with a good quality ERCP to clearly visualize the site of obstruction and overall anatomy of the biliary tree. Preoperative antibiotics are usually given to decrease the risk of cholangitis. A sphincterotomy is usually
Endoscopic stenting of colorectal obstruction
An estimated 6% of Americans will develop colorectal carcinoma, making it the fourth most common carcinoma in this country. In patients presenting with colonic obstruction, colon carcinoma is the cause in more than 50% of cases. Obstruction occurs more frequently in the left colon, which is of smaller diameter and less distensible than the right colon. In the past, colonic decompression was usually achieved through surgical diverting colostomy. More definitive surgery, if possible, would
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