An instant rare complication: a fractured metallic pyloric stent

Abstract

SUMMARYMetallic pyloric stenting (also termed as metallic enteral stenting) performed endoscopically, stands as first-line treatment for malignant gastric outlet obstruction. With reported evidence, these self-expandable metallic stents (SEMS) re-enable oral food intake, preventing patients having to face invasive techniques such as surgical gastroenterostomy. We report a patient having received a covered pyloric SEMS insertion following a tumour growth causing stenosis in the gastric antropyloric region. After 3 weeks, the patient presented with a fracture of the pyloric SEMS, a rare complication, resulting in a second pyloric SEMS insertion. BACKGROUND

Self-Expandable Metallic Stent Placement in Malignant Gastric Outlet Obstruction

“…A case report and a study ever reported this as a late stent complication. 16 , 17 In this study, all of stent fractures occurred in the Bonastent group. However, the rates of overall stent dysfunction, restenosis, reintervention, and clinical success were still comparable between the 2 groups.…”

Fracture of a Self-expandable Metallic Stent Inserted for Malignant Gastric Outlet Obstruction

“…Complications of SEMS placement for malignant GOO, such as tumor ingrowth, tumor overgrowth, food impaction, stent migration, stent occlusion, and perforation have been reported ( 3 , 4 ); however, stent fracture is rare. In the literature, the incidence of stent fracture is reported to be 0-4.8% ( 1 , 3 , 5 - 8 ), but detailed case reports are very rare ( 9 , 10 ).…”

Fracture of a Colonic Self-expandable Metallic Stent in Malignant Colonic Obstruction

“…Other minor complications, such as fever (1.4%) ( 1 ), abdominal pain (0.2-1.2%) ( 1 , 2 ), and bleeding (0.4-5.0%) ( 2 , 5 ), have also been reported. Several reports have shown stent fractures of biliary ( 6 , 7 ), esophageal ( 8 ), and duodenal stents ( 9 , 10 ). On the other hand, the details of fractures of colorectal stents have not yet been reported in the literature; the present case is the first such report and suggests a clinical approach to the long-term management of colorectal SEMSs.…”

“…SEMSs are subject to stronger shearing forces in the flexure because of peristalsis and respiratory movement, and metal fatigue due to prolonged frictional forces could be a factor in such stent fracturing. Fractures of metallic stents have previously been described with biliary ( 6 , 7 ), esophageal ( 8 ) and gastroduodenal stents ( 9 , 10 ). In the biliary and esophageal cases, thermal straining such as radiation therapy or electromechanical effort could have result in stent fracture.…”