Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Technology Insight: enteral stenting and new technology

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 365–374 (2005)Cite this article

Abstract

Self-expandable metal stents (SEMS) have gained acceptance for use in the gastrointestinal tract in order to relieve malignant luminal obstruction. In the upper gastrointestinal tract SEMS are used as an alternative to surgical bypass for palliation of malignant gastric-outlet obstruction. In the colon, SEMS are used to avoid colostomy during palliation and as a bridge to surgery for left-sided colonic obstruction. Enteral SEMS appear to be cost effective. This article reviews the latest in stent technology as well as the outcomes following their placement.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Gastric-outlet obstruction after Whipple procedure.
Figure 2: Malignant gastroduodenal stricture.
Figure 3: Malignant transverse colon obstruction.
Figure 4: A 9 cm obstructive malignant stricture of the rectosigmoid colon.

Similar content being viewed by others

References

  1. Baron TH (2001) Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 31: 1681–1687

    Article  Google Scholar 

  2. Topazian M et al. (1992) Palliation of obstructing gastric cancer with steel mesh, self-expanding endoprostheses. Gastrointest Endosc 38: 58–60

    Article  CAS  Google Scholar 

  3. Maetani I et al. (2000) Knitted nitinol stent insertion for various intestinal stenoses with a modified delivery system. Gastrointest Endosc 54: 364–367

    Article  Google Scholar 

  4. Maetani I et al. (2002) Technical modifications and strategies for stenting gastric outlet strictures using esophageal endoprostheses. Endoscopy 34: 402–406

    Article  CAS  Google Scholar 

  5. Mosler P et al. (2005) Palliation of gastric outlet obstruction and proximal small bowel obstruction with self-expandable metal stents: a single center series. J Clin Gastroenterol 39: 124–128

    PubMed  Google Scholar 

  6. Fiori E et al. (2004) Palliative management of malignant antro-pyloric strictures. Gastroenterostomy vs endoscopic stenting. A randomized prospective trial. Anticancer Res 24: 269–271

    PubMed  Google Scholar 

  7. Johnsson E et al. (2004) Palliation of malignant gastroduodenal obstruction with open surgical bypass or endoscopic stenting: clinical outcome and health economic evaluation. World J Surg 28: 812–817

    Article  Google Scholar 

  8. Mittal A et al. (2004) Matched study of three methods for palliation of malignant pyloroduodenal obstruction. Br J Surg 91: 205–209

    Article  CAS  Google Scholar 

  9. Dormann A et al. (2004) Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 36: 543–550

    Article  CAS  Google Scholar 

  10. Adler DG and Baron TH (2002) Endoscopic palliation of malignant gastric outlet obstruction using self-expandable metal stents: experience in 36 patients. Am J Gastro 97: 72–78

    Article  Google Scholar 

  11. Song HY et al. (2004) A dual expandable nitinol stent: experience in 102 patients with malignant gastroduodenal strictures. J Vasc Interv Radiol 15: 1443–1449

    Article  Google Scholar 

  12. Kim GH et al. (2004) Which types of stent, uncovered or covered, should be used in gastric outlet obstructions? Scand J Gastroenterol 39: 1010–1014

    Article  CAS  Google Scholar 

  13. Holt AP et al. (2004) Palliation of patients with malignant gastroduodenal obstruction with self-expanding metallic stents: the treatment of choice? Gastrointest Endosc 60: 1010–1017

    Article  Google Scholar 

  14. Telford JJ et al. (2004) Palliation of patients with malignant gastric outlet obstruction with the enteral Wallstent: outcomes from a multicenter study. Gastrointest Endosc 60: 916–920

    Article  Google Scholar 

  15. Bethge N et al. (1996) Human tissue responses to metal stents implanted in vivo for the palliation of malignant stenoses. Gastrointest Endosc 43: 596–602

    Article  CAS  Google Scholar 

  16. Choi YB (2002) Laparoscopic gastrojejunostomy for palliation of gastric outlet obstruction in unresectable gastric cancer. Surg Endosc 16: 1620–1626

    Article  Google Scholar 

  17. Dohmoto M (1991) Endoscopic implantation of rectal stents in palliative treatment of malignant stenosis. Endosc Dig 3: 1507–1512

    Google Scholar 

  18. Baron TH (2003) Benign and malignant colorectal strictures. In Colonoscopy: principles and practice, 611–623 (Eds Waye JD et al.) Massachusetts: Blackwell Publishing

    Chapter  Google Scholar 

  19. Tejero E et al. (1994) New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum 37: 1158–1159

    Article  CAS  Google Scholar 

  20. Horiuchi A et al. (2001) Usefulness of Dennis colorectal tube in endoscopic decompression of acute, malignant colonic obstruction. Gastrointest Endosc 54: 229–232

    Article  CAS  Google Scholar 

  21. Tanaka T et al. (2001) Endoscopic transanal decompression with a drainage tube for acute colonic obstruction: clinical aspects of preoperative treatment. Dis Colon Rectum 44: 418–422

    Article  CAS  Google Scholar 

  22. Saida Y et al. (2003) Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 46 (Suppl): S44–S49

    PubMed  Google Scholar 

  23. Repici A et al. (2000) Self-expanding covered esophageal Ultraflex stent for palliation of malignant colorectal anastomotic obstruction complicated by multiple fistulas. Gastrointest Endosc 51: 346–348

    Article  CAS  Google Scholar 

  24. Khot UP et al. (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89: 1096–1102

    Article  CAS  Google Scholar 

  25. Sebastian S et al. (2004) Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99: 2051–2057

    Article  Google Scholar 

  26. Binkert CA et al. (1998) Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents – a preliminary report. Radiology 206: 199–204

    Article  CAS  Google Scholar 

  27. Xinopoulos D et al. (2004) Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis. Surg Endosc 18: 421–426

    Article  CAS  Google Scholar 

  28. Osman HS et al. (2000) The cost-effectiveness of self-expanding metal stents in the management of malignant left-sided large bowel obstruction. Colorectal Dis 2: 233–237

    Article  CAS  Google Scholar 

  29. Targownik LE et al. (2004) Colonic stent vs emergency surgery for management of acute left-sided malignant colonic obstruction: a decision analysis. Gastrointest Endosc 60: 865–874

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastroenterology Fellow and Instructor in Medicine Mayo Clinic College of Medicine, Rochester, MN, USA

    Dia T Simmons

  2. Professor of Medicine and Consultant, and Director of Pancreaticobiliary Endoscopy, at the Mayo Clinic College of Medicine, Rochester, MN, USA

    Todd H Baron

Authors
  1. Dia T Simmons
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Todd H Baron
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Todd H Baron.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Glossary

STENT MIGRATION

A complication of stent placement, in which the stent is displaced proximally or distally

TUMOR INGROWTH

A complication of stent placement in which tumor growth extends between the struts of a stent into the lumen

TUMOR OVERGROWTH

A complication of stent placement in which tumor growth extends beyond the length of a previously placed luminal stent

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simmons, D., Baron, T. Technology Insight: enteral stenting and new technology. Nat Rev Gastroenterol Hepatol 2, 365–374 (2005). https://doi.org/10.1038/ncpgasthep0236

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpgasthep0236

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing