Endoprosthetics for Luminal Obstruction
- Enteral stents are endoscopic medical devices used to treat gastrointestinal strictures. Since the first primitive stent, improvements in enteral stents design and composition have been made. Currently, different kinds of stents with different shapes, sizes, calibers, and materials have been introduced. Gastrointestinal stents can be manufactured from plastic, metal, or biodegradable material. The new different composition of the stents are crucial for the correct function of the devices and guarantee physical properties able to improve clinical outcomes.
- Gastric outlet obstruction (GOO) is a clinical entity characterized by postprandial vomiting, epigastric abdominal pain, bloating or discomfort, early satiety, and eventually weight loss. GOO may not be clinically evident until high-grade obstruction occurs due to the unique ability of the stomach to distend significantly to accommodate large volumes. GOO is caused by mechanical gastroduodenal obstruction or motility disorders and can be divided into 3 major categories: benign mechanical, malignant mechanical, and motility disorders.
- Endoscopic esophageal stents are widely applied in the management of patients with malignant strictures . A less frequent reason to consider esophageal stent placement is a benign esophageal stricture. Benign esophageal strictures may result from a large variety of causes, including but not limited to peptic injury, caustic injury, and iatrogenic injury (eg, anastomotic, radiation-induced, endoscopic resection) . Dysphagia symptoms resulting from these strictures may seriously impair quality of life.
- While traditionally employed to manage malignant gastrointestinal (GI) obstruction, a variety of luminal stents have been employed in the management of refractory benign GI strictures with varying safety and efficacy profiles. These include: self-expanding metal stents (SEMS), self-expanding plastic stents (SEPS), biodegradable stents and lumen-apposing metal stents (LAMS). LAMS have become instrumental as an alternate strategy to treat benign gastric outlet obstruction in the setting of native and postsurgical anatomy.
- Given the increasing prevalence and incidence of colorectal cancer, more patients will suffer from colonic obstruction and therefore need appropriate treatment. Currently, patients can undergo either emergency surgery (ES), which encompasses colostomy, or endoscopic self-expandable metal stent (SEMS) placement. However, ES carries a substantial risk of morbidity and mortality; therefore, attention has been increasingly drawn on the endoscopic placement of SEMS. SEMS can be inserted under endoscopic and/or fluoroscopic view.
- Endoluminal stenting serves as an essential tool in the gastroenterologist's arsenal to manage perforations, leaks, fistulas, and both benign and malignant strictures; however, the heterogeneity of stent design, indication, and location renders comprehensive and systemic comparison of their efficacy a perennial challenge, despite their widespread use. Appraisal of their associated risks faces similar obstacles. Given the lack of robust, randomized, prospective data, understanding the complications of stents, as well as prevention and management of these complications, becomes all the more critical for those who use stents and/or manage patients with these important therapeutic devices.