ABSTRACT
Stent placement is being increasingly used to palliate malignant obstructions of the gastrointestinal tract. Stents were initially limited to esophageal strictures and the use of plastic prosthetic tubes. However, the introduction of self-expandable metallic stents (SEMSs) has allowed physicians to place stents at the gastroduodenal or colorectal obstructions, which may have a curved anatomy. Several types of dedicated stents are currently available commercially.
For most patients, stent placement is markedly effective in relieving obstructive symptoms and allowing the resumption of oral intake, generally more rapidly than with palliative surgeries. Furthermore, as it is less invasive and requires a shorter procedure time and only conscious sedation, stent placement may be generally favorable as excessive surgical stress is avoided.
Although mortality and life-threatening complications are rare, a variety of complications, including obstruction and migration, develop over time in approximately 10%–30% of cases. Most of these complications are manageable, usually by placing an additional stent; however, surgical intervention might be preferable in patients with longer life expectancy or better performance status because of lower need for reintervention. Currently available stents should be redesigned to reduce the occurrence of complications and to prolong stent patency.
Presently, SEMSs play an important role in the palliative care of various obstructions of the gastrointestinal tract. This chapter describes the available technology, techniques, and outcomes associated with stent placement in the esophagus, gastroduodenum, and colon.
