Gastrointestinal stents: Thinking outside the box

Abstract

While traditionally employed to manage malignant gastrointestinal (GI) obstruction, a variety of luminal stents have been employed in the management of refractory benign GI strictures with varying safety and efficacy profiles. These include: self-expanding metal stents (SEMS), self-expanding plastic stents (SEPS), biodegradable stents and lumen-apposing metal stents (LAMS). LAMS have become instrumental as an alternate strategy to treat benign gastric outlet obstruction in the setting of native and postsurgical anatomy. This includes transpyloric placement as well as EUS-guided gastrojejunostomy creation as an alternative to laparoscopic gastrojejunostomy and endoluminal stenting. The novel application of LAMS for complete endoscopic management with anastomotic decompression of afferent loop syndrome has also been met with success in case reports and series. This approach with LAMS obviates the need for external drains and complex repeat surgeries. Finally, SEMS have been used to address benign and malignant strictures of the small bowel. However, SEMS use for this indication has been hindered by limitations in endoscopic accessibility of target sites and the current state of stent delivery systems. Whereas the role of colonic stenting for malignant colonic obstruction is well-established, the use of stents to treat benign colonic strictures continues to evolve. While the existing armamentarium of GI luminal stents has revolutionized the management of a variety of clinical conditions, additional advances could further broaden the potential applications of these devices.