Placement of Enteral Self-Expandable Metal Stents



Placement of Enteral Self-Expandable Metal Stents


Aaron J. Small, MD

Shayan Irani, MD



Enteral self-expandable stents (SEMSs) have become an effective treatment option for malignant strictures of the esophagus, stomach, proximal small bowel, gastroenteric anastomoses, and the distal small bowel (terminal ileum) or the jejunum in select patients.1,2 The goal is to achieve luminal patency, allowing food intake per os, and thereby obviating the need for more invasive operative alternatives. SEMSs although historically made of stainless steel now are almost exclusively made of nitinol (a shape-retaining alloy) and come in a variety of sizes and designs depending on the location of the stenosis. For the purposes of this chapter, we will focus on the application of metallic stenting within the lumen of the stomach and proximal small intestine, most commonly the duodenum. Endoscopic transmural stenting within the stomach and small intestine akin to the creation of an endoscopic anastomotic bypass is covered elsewhere in this handbook.


PATIENT SELECTION






PATIENT PREPARATION


Preprocedural Planning and Equipment


Prerequisites



  • 1. A basic prerequisite for placing enteral stents requires an endoscopy unit equipped with various endoscopes, stent types (discussed further below), high-quality fluoroscopy, and staff including endoscopic technicians/assistants, fluoroscopic operators, and anesthesia all of whom are comfortable with complex GI procedures.


  • 2. In addition, knowledge of the patient’s anatomy and any history of prior surgeries should be understood to determine the feasibility of endoluminal stenting.


Imaging



  • 1. CT scan with oral contrast can elucidate the location, length, severity of the stricture, and the presence of a possible leak.


  • 2. Upper GI series and/or small bowel follow through studies while more detailed than CT scans in defining gastroduodenal strictures may also aid in determining whether there are multiple other focal areas of stenosis in the more distal small bowel.


Procedural considerations

Precautions to minimize the higher risk of intraprocedural aspiration in these patients who may have complete gastric outlet obstruction should be undertaken. Some of the interventions that may reduce this aspiration risk are the following:

May 29, 2020 | Posted by in GASTROENTEROLOGY | Comments Off on Placement of Enteral Self-Expandable Metal Stents
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