Best Practices in Esophageal, Gastroduodenal, and Colonic Stenting

Abstract

Endoscopic stenting is an area of endoscopy that has witnessed noteworthy advancements over the last decade, resulting in evolving clinical practices among gastroenterologists around the world. Indications for endoscopic stenting have progressively expanded, becoming a frequent part of the management algorithm for various benign and malignant conditions of the gastrointestinal tract, from esophagus to rectum. In addition to expanded indications, continuous technological enhancements and development of novel endoscopic stents have resulted in an increased success of these approaches and, in some cases, allowed new applications. This review aimed to summarize best practices in esophageal, gastroduodenal, and colonic stenting.

How to Prevent and Treat the Most Frequent Adverse Events Related to Luminal Dilation and Stenting in Benign Disease

“…Stent placement as a salvage therapy for benign gastric outlet obstruction is limited by a high risk of stent migration, with no evidence to recommend stents over surgery (9). SEMS use in the context of benign colonic conditions is supported only by limited available data (10) and is associated with major AE, especially migration and perforation (11). Their use should therefore be considered only on a case-by-case basis after multidisciplinary team discussion.…”

“…Although SEMS are associated with a non-negligible risk of AE, most of them are mild and can be conservatively managed. The main AE include migration, transitory nausea, vomiting and/ or pain, and stent-induced strictures (11). The ideal stent should have a simple deployment system, good visibility on fluoroscopy, a radial force that is high enough to allow good expansion but without causing pain or pressure necrosis of the adjacent wall, high flexibility and conformability at angulations and flexures of the gastrointestinal wall, resistance to obstruction and migration, and the ability to be easily removed.…”

An unconventional retrograde approach for self-expanding metallic stent delivery in oesophagus cancer palliation

“…Oesophageal cancer is a deadly disease with a poor prognosis [1] . To open the occluded oesophagus lumen, self-expanding metallic stents are often required to palliate the dysphagia symptoms [2,3,4] . In these situations, partially or fully covered stents are valid options [4,5] .…”