Treatment of gastric outlet and duodenal obstructions with uncovered expandable metal stents

Enteral stents for malignant gastric outlet obstruction

Malignant gastric outlet obstruction (GOO) is a commonly encountered entity, defined as the inability of the stomach to empty because of mechanical obstruction at the level of either the stomach or the proximal small bowel. In this article, current literature on GOO is reviewed with a focus on enteral stents to include symptoms and diagnosis, stent and nonstent treatment, types of enteral stents, indications and contraindications to stent placement, and technical and clinical success rates. In comparison with gastrojejunostomy, enteral stent placement is better suited for patients with a shorter life expectancy and/or those who are poor surgical candidates.

Esophageal stent migration can lead to intestinal obstruction

BACKGROUND

Self-expanding metallic stents are the devices of choice in the treatment of malign or benign strictures of the esophagus. Stent migration is a well-known complication of this procedure.

AIMS

We report a case of intestinal obstruction caused by esophageal stent migration, in which surgical intervention was used.

METHODS

A 65-year-old woman, who had a medical history of gastric cancer operations and esophageal stent applications, was admitted to our emergency department with a 48-hour history of abdominal pain, nausea and vomiting. An emergency laparotomy was performed and the migrated stent causing intestinal obstruction was removed.

RESULTS

The patient recovered without incident and was discharged on postoperative day 3.

CONCLUSION

This case illustrates that esophageal stent migration has to be considered as a potential life-threatening complication.

Endoscopic stenting-Where are we now and where can we go?

Self expanding metal stents (SEMS) play an important role in the management of malignant obstructing lesions in the gastrointestinal tract. Traditionally, they have been used for palliation in malignant gastric outlet and colonic obstruction and esophageal malignancy. The development of the polyflex stent, which is a removable self expanding plastic stent, allows temporary stent insertion for benign esophageal disease and possibly for patients undergoing neoadjuvant chemotherapy prior to esophagectomy. Potential complications of SEMS insertion include perforation, tumour overgrowth or ingrowth, and stent migration. Newer stents are being developed with the aim of increasing technical and clinical success rates, while reducing complication rates. Other areas of development include biodegradable stents for benign disease and radioactive or drug-eluting stents for malignant disease. It is hoped that, in the future, newer stents will improve our management of these difficult conditions and, possibly, provide prognostic as well as symptomatic benefit in the setting of malignant obstruction.