Pancreaticobiliary and Gastrointestinal Stents

Todd H. Baron, MD, Guest Editor

When searching PubMed, the term “stent” first appeared in the title of a publication in 1952. At the time of this writing, a search in PubMed using “stent” produced 52,629 articles. The origin has been conjectured to be from the Scottish word stynt or stent, meaning stretched out river fishing nets (an extension if you will). However, in an excellent review by Sterioff on the etymology of the word stent, it is widely accepted that the word evolved from Stent’s compound, created by British dentist Charles. T. Stent (1807–1885) and used for dental impressions. Subsequently, in 1917 a surgeon, Johannes F.S. Esser (1877–1946), used the compound for facial plastic surgery and referred to it as Stent’s mould. In 1954, William H. Re Mine and John H. Grindlay used Stent’s principle to create omentum-lined plastic tubes in the reconstruction of canine bile ducts ; surgically placed biliary tubes (stents) were quickly adopted. In 1974 Molnar and Stockum were the first to describe percutaneous placement of a plastic biliary stent and in 1979 Soehendra and Reynders-Frederix described endoscopic placement for palliation of malignant biliary obstruction. Development of expandable metal stents for endoscopic use lagged behind cardiology and interventional radiology use, and expandable metal stents were first developed for palliation of malignant biliary and esophageal obstruction followed by stents developed for palliation of gastroduodenal and colonic obstruction. It is remarkable that endoscopic gastrointestinal stent technology (stents passed through endoscopes) is relatively recent, with expandable metal stents first used within the last 20 years.

At the present time endoscopic “rigid” plastic stents are used only for pancreatic and biliary indications use, while expandable metal stents are used in the biliary tree (rarely in the pancreas) and the remaining areas in the gastrointestinal tract. With technological advances in guidewires, stent and endoscope design stents are now used for the palliation and definitive treatment of benign and malignant disease of the pancreaticobiliary and gastrointestinal tract.

I have been fortunate to witness the evolution of gastrointestinal stents. As a first-year endoscopy fellow in 1991, I recall being involved in the placement of a rigid esophageal stent for palliation of malignant dysphagia and as a third-tier biliary fellow in 1993 being involved with the placement of an expandable metal biliary stent, which had only recently become FDA approved for endoscopic palliation. Shortly after completion of my fellowship, FDA-approved expandable esophageal stents became available. We subsequently used esophageal and biliary stents for gastric, duodenal, and colonic use as the development of stents specifically for these latter indications did not come for several more years. It has been satisfying to be able to use plastic and metal stents to positively impact the clinical course of ill patients and in many cases have achieved dramatic clinical improvements after placing them for palliative, preoperative, and curative intents.

In this issue of Gastrointestinal Endoscopy Clinics of North America a series of articles are published that review the use of rigid and expandable metal stents throughout the gastrointestinal tract. As an overview, the initial article discusses tissue responses to expandable stents. Separate articles on the use of expandable stents for benign esophageal and biliary disease, malignant esophageal and biliary disease, and malignant colonic obstruction are included. Likewise, separate articles on rigid plastic stent use for benign and malignant biliary indications and for pancreatic use are discussed. Finally, the use of expandable stents in unusual locations is presented.

It is hoped that the information in this issue will increase your understanding of stent use that will translate into improvement in patient care. Along the way it is also hoped that you will be able to appreciate the historical aspects of stent development.

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