Enteral stents: Complications and their management

Abstract

The treatment of malignant colonic and gastric outlet obstruction with self-expanding metallic stents (SEMS) is an established technique that can be performed by radiologic or a combination of radiologic and endoscopic guidance. The procedure is very effective to relieve the obstructive symptoms of advanced malignancies, with important clinical benefits and significant improvement in quality of life for the patients. Despite much advancement in the designs of SEMS, enteral stent placement is still associated with some significant early and late complications. Stent dysfunction mainly caused by tumor ingrowth/over growth, and stent migration when covered stent are used, are relatively common complications and many times require reinterventions.

Interventional Radiology Management of Vascular Complications From Gastrointestinal Interventions

“…Overall, bleeding is usually self-limited, often with spontaneous resolution and a reported incidence of 1% to 6%. 1,3 Bleeding occurs more frequently secondary to irritation Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™.…”

Case Report of Surgical Management of Duodenal Perforation Secondary to Stent in a Patient With Gastric Outlet Obstruction Due to a Rare Neuroendocrine Adenocarcinoma of Duodenum

“…GI perforation due to stent placement can occur in up to 5% of patients, leading to the patient’s death in 1% of these procedures [ 2 , 3 ]. Perforations that occur during the placement of the stent are usually due to guidewire insertion [ 4 ]. In most cases, perforations are recognized after placement when patients complain of severe abdominal pain and a CT scan of the abdomen shows the presence of free air [ 4 ] as was seen in our patient.…”

“…Management of GI perforations from stent placement is commonly managed with an endoscopic repair that can entail stent removal and clip placement to seal the perforation or endoscopic placement of a covered stent if the perforation is small and the patient has no evidence of peritonitis on clinical exam [ 3 , 4 ]. In our case, the patient had evidence of peritonitis on exam and was deteriorating clinically.…”

“…Recent research suggests that surgery may be a more favorable treatment plan when patients have a life expectancy greater than two months, while patients with advanced or metastatic disease and patients experiencing malnutrition and biliary obstruction may benefit more from stent placement [ 4 ]. Even with these recommendations, SEMS is still the treatment of choice in some institutions due to its less invasive nature and small complication rate [ 4 ].…”

EUS-guided gastrojejunostomy with an esophageal fully covered self-expanding metal stent for the management of benign afferent loop obstruction

“…Our patient’s ALO was treated with EUS-guided gastrojejunostomy instead of surgery, with the goal of decreasing hospitalization time, initiating oral intake sooner, and lowering overall cost. 11 Given the near-normal life expectancy of our patient, percutaneous approaches were not pursued (ie, direct percutaneous tube enterostomy, transhepatic and direct percutaneous insertion of a self-expanding enteric stent). 12 We chose to create a diverting gastrojejunostomy using a 20-mm esophageal FCSEMS because a 20-mm electrocautery-enhanced LAMS (ECE-LAMS) was not commercially available at the time of this procedure (ie, 15-mm ECE-LAMS was the maximum available size).…”