[Show abstract][Hide abstract] ABSTRACT: Self-expanding metal stents have become a leading palliative therapy for dysphagia resulting from esophageal, proximal gastric, and mediastinal cancers. Increasingly, fully covered self-expanding plastic stents and now fully covered metal stents have been used to treat a variety of benign esophageal conditions as well as cancer. Several stent designs are available in the United States and many more internationally. Each design has advantages and limitations. Knowledge of the indications for esophageal stenting and the common side effects associated with different designs allows physicians to choose the best stent for a given condition as well as to anticipate complications such as stent migration or restenosis. Compared with partially covered stents, newer, fully covered metal stents may promote less granulation tissue and subsequent stenosis and may be removable even after several weeks. However, the tradeoff may be more frequent migration. Interest in fully covered metal stents in place of fully covered plastic stents for use in strictures and leaks has also grown, despite the lack of a formal indication for metal stents in benign disease. Unfortunately, rigorous studies of newer stent designs are currently lacking.
Advances in Therapy 07/2010; 27(7):413-25. · 2.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The use of self-expanding metal esophageal stents has evolved dramatically over the last 20 years. Stents themselves have morphed from simple open-mesh wire devices to a variety of partially and fully covered metal and plastic protheses designed to resist in-growth and migration. Indications include grown considerably from simply palliating malignant dysphagia to the treatment of benign conditions such as refractory strictures, perforations, and fistulas, bridging tumors through neoadjuvant therapy and even serving as support for mucosal healing after ablative therapies. This article describes the current experience with esophageal stenting for malignant and benign conditions and examines new innovations in stent design and applications.
Gastrointestinal endoscopy clinics of North America 01/2010; 20(1):103-21, vii.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Anastomotic leakages are severe complications of upper gastrointestinal surgery with serious morbidity and mortality. Until recently, only abscess drainage was possible. Since 2007, removable and repositionable covered metal self-expandable stents (RReCoMSeS) have been used in our hospital to cover leaks. METHODS: Patients with postsurgical gastrointestinal leaks treated with RReCoMSeS between January 2007 and March 2010 were retrospectively evaluated and described. RESULTS: Twenty-six patients were treated with RReCoMSeS (totally covered Choo/Hanaro and partially covered Endoflex stents). Included patients had anastomotic leaks after esophagectomy (15) and bariatric surgery (11). Overall successful sealing of the leak occurred in 81 % (including multiple procedures). In total 33 RReCoMSeS were used (mean 1.3 stents and 1.7 procedures per patient). Twenty-one of 33 RReCoMSeS succeeded in sealing the leak (64 %). Migration occurred in 24 % RReCoMSeS, and 9 % disintegrated. One stent (3 %) caused a perforation. CONCLUSIONS: RReCoMSeS are a safe alternative for treating postsurgical leaks in the upper gastrointestinal tract. In 81 % of patients and with 64 % of the inserted stents, leaks were sealed successfully, with few complications. Fewer stents per patient were needed thanks to their repositionability. Stent migration is a major problem.
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