Digestive Disease Interventions 2018; 02(01): 003-010
DOI: 10.1055/s-0038-1639613
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Gastrointestinal Stents: Materials and Designs

Steven John Black
1   MDECON Ltd., Conwy, United Kingdom
,
Derek William Edwards
2   Department of Radiology, The Christie NHS Foundation Trust, Manchester, United Kingdom
3   Department of Natural Sciences, University of Chester, Chester, United Kingdom
,
Graham Compton Smith
3   Department of Natural Sciences, University of Chester, Chester, United Kingdom
,
Hans-Ulrich Laasch
2   Department of Radiology, The Christie NHS Foundation Trust, Manchester, United Kingdom
3   Department of Natural Sciences, University of Chester, Chester, United Kingdom
› Author Affiliations
Further Information

Publication History

09 October 2017

14 February 2018

Publication Date:
09 May 2018 (online)

Abstract

Over the past 25 years, stents have developed into an established way of restoring luminal patency throughout the gastrointestinal tract. Materials used as well as the construction of these devices have become more and more sophisticated to comply better with the complex environment they are inserted in. The requirements vary greatly from organ to organ and stent behavior differs significantly between stent constructions. However, this is not necessarily appreciated by many operators. The choice of devices is now vast, and in many cases, decisions are made on availability and cost. An increasing challenge in malignant conditions is the improving survival of incurable patients, which now exceeds the traditional life expectancy of a stent by a factor of 2 to 3. Consequently, more patients experience failure of their stent and require repeat interventions. This has a poor impact on patients' quality of life and potentially on their survival. Re-intervention is often more difficult, carries the risk of additional complications, and presents an additional economic burden to the health systems.

This article illustrates current stent designs, their different behaviors, and limitations.

 
  • References

  • 1 Song HY, Choi KC, Cho BH, Ahn DS, Kim KS. Esophagogastric neoplasms: palliation with a modified gianturco stent. Radiology 1991; 180 (02) 349-354
  • 2 Baron T, Kozarek RA. Esophageal stents: benign. In: Kozarek R, Baron TH, Song HY. , eds. Self-Expandable Stents in the Gastrointestinal Tract. New York: Springer; 2013: 205-216
  • 3 Laasch H-U, Lee S, Moss J, Roobottom C, Kinsman R, Walton P. British Society of Interventional Radiology. ROST – Registry of Oesophageal Stenting, First Report 2004. Henley-on-Thames: Dendrite Clinical Systems; 2004
  • 4 Rice TW, Rusch VW, Ishwaran H, Blackstone EH. ; Worldwide Esophageal Cancer Collaboration. Cancer of the esophagus and esophagogastric junction: data-driven staging for the seventh edition of the American Joint Committee on Cancer/International Union Against Cancer Cancer Staging Manuals. Cancer 2010; 116 (16) 3763-3773
  • 5 Hirdes MM, Vleggaar FP, de Beule M, Siersema PD. In vitro evaluation of the radial and axial force of self-expanding esophageal stents. Endoscopy 2013; 45 (12) 997-1005
  • 6 Gokul K, Squire E, Artioukh D. Colonic perforation as a late complication of self-expanding stent. Interv Med Appl Sci 2014; 6 (03) 131-132
  • 7 Odurny A. Colonic anastomotic stenoses and Memotherm stent fracture: a report of three cases. Cardiovasc Intervent Radiol 2001; 24 (05) 336-339
  • 8 Peck R, Wattam J. Fracture of Memotherm metallic stents in the biliary tract. Cardiovasc Intervent Radiol 2000; 23 (01) 55-56
  • 9 Suzuki N, Saunders BP, Thomas-Gibson S, Marshall M, Halligan S, Northover JM. Complications of colonic stenting: a case of stent migration and fracture. Endoscopy 2003; 35 (12) 1085
  • 10 Yoshida H, Mamada Y, Taniai N. , et al. Fracture of an expandable metallic stent placed for biliary obstruction due to common bile duct carcinoma. J Nippon Med Sch 2006; 73 (03) 164-168
  • 11 Sriram PV, Ramakrishnan A, Rao GV, Nageshwar Reddy D. Spontaneous fracture of a biliary self-expanding metal stent. Endoscopy 2004; 36 (11) 1035-1036
  • 12 Yoshida H, Tajiri T, Mamada Y. , et al. Fracture of a biliary expandable metallic stent. Gastrointest Endosc 2004; 60 (04) 655-658
  • 13 Orive-Calzada A, Alvarez-Rubio M, Romero-Izquierdo S. , et al. Severe epithelial hyperplasia as a complication of a novel biodegradable stent. Endoscopy 2009; 41 (Suppl. 02) E137-E138
  • 14 Hair CS, Devonshire DA. Severe hyperplastic tissue stenosis of a novel biodegradable esophageal stent and subsequent successful management with high-pressure balloon dilation. Endoscopy 2010; 42 (Suppl. 02) E132-E133
  • 15 Dumoulin FL, Plassmann D. Tissue hyperplasia following placement of a biodegradable stent for a refractory esophageal stricture: treatment with argon plasma coagulation. Endoscopy 2012; 44 (Suppl 2 UCTN): E356-E357
  • 16 Fiocca F, Cereatti F, Antypas P, Donatelli G. Argon plasma coagulation: a less-expensive alternative to the “stent-in-stent” technique for removal of embedded partially covered esophageal stents. Gastrointest Endosc 2016; 83 (02) 453
  • 17 Hirdes MM, Siersema PD, Houben MH, Weusten BL, Vleggaar FP. Stent-in-stent technique for removal of embedded esophageal self-expanding metal stents. Am J Gastroenterol 2011; 106 (02) 286-293
  • 18 Kauffman GB, Mayo I. The story of nitinol: the serendipitous discovery of the memory metal and its applications. Chem Educ 1997; 2 (02) 1-21
  • 19 Kim CG, Choi IJ. Enteric prostheses. In: Kozarek R, Baron TH, Song HY. , eds. Self-Expandable Stents in the Gastrointestinal Tract. New York: Springer; 2013: 103-120
  • 20 Itoi T, Sofuni A, Itokawa F, Tonozuka R, Ishii K. Current status and issues regarding biliary stenting in unresectable biliary obstruction. Dig Endosc 2013; 25 (Suppl. 02) 63-70
  • 21 Perri V, Boškoski I, Tringali A. , et al. Prospective evaluation of the partially covered nitinol “ComVi” stent for malignant non hilar biliary obstruction. Dig Liver Dis 2013; 45 (04) 305-309
  • 22 Grimley CE, Bowling TE. Oesophageal metallic stent dysfunction: first reported case of stent fracture and separation. Endoscopy 1999; 31 (06) S45
  • 23 Khara HS, Diehl DL, Gross SA. Esophageal stent fracture: case report and review of the literature. World J Gastroenterol 2014; 20 (10) 2715-2720
  • 24 Sze SF, Chapman MH, Webster GJ. Education and imaging. Gastrointestinal: covered duodenal metal stent fracture and its removal with “lasso” technique. J Gastroenterol Hepatol 2015; 30 (12) 1693