Complications and Lessons Learned from 10 Years of Expandable Gastrointestinal Prostheses

Abstract

Initially inserted percutaneously for malignant biliary stenoses, expandable gastrointestinal prostheses have evolved as primary treatment for malignant dysphagia and as an alternative to plastic prostheses for some types of obstructive jaundice. They are also in their infancy as a means to palliate unresectable obstructions of the gastric outlet, small bowel, and colorectum. Despite a decade of development, problems persist and include: maldeployment; inadequate expansion; ingrowth; overgrowth; erosion, and migration. This article outlines some of the problems noted and opportunities to improve this still-evolving technology.

Delayed Complications after Placement of Self-Expanding Stents in Malignant Esophageal Obstruction: Treatment Strategies and Survival Rate

“…Recurrent dysphagia being the leading symptom of stent dysfunction has been observed in this study and by others in as many as 50% of patients during a follow-up of 4-10 weeks [10,11]. Recanalization procedures such as laser therapy or further stent insertion, but also systemic chemotherapy and radiation seem to be of major importance to prolong stent patency [4,[6][7][8][9][10][11][12][13][14].…”

“…However, favorable factors such as ease of placement, rapid relief of dysphagia, and improvement of quality of life should be weighed against delayed complications, including tumor in-or overgrowth, food bolus obstruction, development of fistulas, and stent migration [3][4][5][6][7]. Recurrent dysphagia being the leading symptom of stent dysfunction has been observed in this study and by others in as many as 50% of patients during a follow-up of 4-10 weeks [10,11].…”

“…Many techniques have been used for palliation such as surgery, placement of plastic prostheses and laser therapy, but the most commonly performed procedure is the placement of self-expanding metal stents [2]. These devices have proven advantages over other modalities, with low rates of serious acute complications and rapid and long-lasting relief of symptoms [3][4][5][6]. However, recurrent dysphagia due to delayed complications such as stent migration, tumor in-and overgrowth, and development of fistulas are common problems [6][7][8][9].…”

“…These devices have proven advantages over other modalities, with low rates of serious acute complications and rapid and long-lasting relief of symptoms [3][4][5][6]. However, recurrent dysphagia due to delayed complications such as stent migration, tumor in-and overgrowth, and development of fistulas are common problems [6][7][8][9]. Therefore, this study was undertaken to relate causal factors with different complications, and to elucidate the efficacy of endoscopic re-intervention.…”

Randomized Comparison of Three Palliative Regimens Including Brachytherapy, Photodynamic Therapy, and APC in Patients With Malignant Dysphagia (CONSORT 1a) (Revised II)

“…Th e fi rst is stenting using rigid self-expandable metal stents (SEMSs). Despite early enthusiasm and a high immediate success rate, more recent studies including longer follow-up report important disadvantages and late complications with this treatment (dislocation, tumor overgrowth or ingrowth, and late fi stulization) ( 1,2 ). Moreover, a recent British randomized trial comparing SEMS vs. plastic stents or other re-canalization interventions showed that patients treated with SEMSs may have worse QoL following the treatment and a shorter survival ( 3 ).…”