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Endoskopie heute 2013; 26(2): 150-160
DOI: 10.1055/s-0033-1335825
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Metallstents im Gastrointestinaltrakt

Self-Expandable Metal Stents in the Gastroenterology Tract – Indications and Fields of Application
A. Eickhoff
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Publication History

Publication Date:
16 July 2013 (online)

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Zusammenfassung

In der Behandlung von benignen und malignen Stenosen des Gastrointestinaltrakts sind selbstexpandierende Metallstents (SEMS) seit über 30 Jahren eine etablierte Behandlungsmethode. Aber auch zur Behandlung von Fisteln, Perforationen, Blutungen oder Zystendrainagen können SEMS erfolgreich eingesetzt werden. SEMS werden heute außer im tieferen Dünndarm in praktisch allen Lokalisationen des Gastrointestinaltrakts implantiert (Ösophagus/Kardia, Magenausgang, Duodenum, Gallen-/Pankreasgang, Kolon/Rektum). Sie weisen je nach Einsatzgebiet verschiedene technische Charakteristika auf. Hierzu zählen Material, Ummantelung, Länge, Diameter und andere zusätzliche Neuerungen wie medikamentenfreisetzende (drug-eluting) Stents, selbstauflösende (biodegradable) Stents oder thermoplastische (thermoplastic) Stents. In der Freisetzungsform unterscheidet man „distal-releasing“ und „proximal-releasing“ Stents als auch über den Arbeitskanal freizusetzende (through the scope/TTS) und radiologisch über einen Draht zu applizierende Stents. Akute Komplikationen sind selten, sie reichen von Blutung, Perforation bis hin zur Obstruktion. Stentmigration und -obstruktion sind die häufigsten Spätkomplikationen.

Abstract

Self-expandable metal stents (SEMS) are well known and established in the therapy of malignant stenosis of the gastrointestinal tract. But they are also used for the treatment of benigne stenosis, fistulas, perforations or bleeding. SEMS are categoried by the material they are made of, the covering, the length, the diameter and other special features like drug-eluting stents, biodegradable stents or thermoplastic stents. The releasing system is differentiated between through the scope systems (TTS) or guide-wire system with fluoroscopy. SEMS are used in the esophagus, the esophago-gastral-junction, the gastric outlet, the duodenum, the bile or pancreatic duct, colon and rectum. Early complications are rare. Stent-migration and occlusion are the main late complication of SEMS.

Schlüsselwörter

selbst expandierende Metallstents - SEMS - Stenose des Gastrointestinaltrakts - Bridge-to-Surgery

Key words

self-expandable metal stents - SEMS - stenosis of the gastrointestinal tract - bridge-to-surgery
 

  • Literatur

  • 1 Mulliken JB, Goldwyn RM. Impressions of Charles Stent. Plast Reconstr Surg 1978; 62: 173-176
    PubMedGoogle Scholar
  • 2 Siersema PD. New developments in palliative therapy. Best Pract Res Clin Gastroenterol 2006; 20: 959-978
    CrossrefPubMedGoogle Scholar
  • 3 Celestin LR. Permanent intubation in inoperative cancer of the oesophagus and cardia. Ann R Coll Surg Eng 1959; 25: 165-170
    PubMedGoogle Scholar
  • 4 Atkinson M, Ferguson R. Fibre-optic endoscopic palliative intubation of inoperable oesophagogastric neoplasms. BMJ 1977; 1: 266-267
    CrossrefPubMedGoogle Scholar
  • 5 Rousseau H, Puel J, Joffre F et al. Self-expanding endovascular prosthesis: an experimental study. Radiology 1987; 164: 709-14
    PubMedGoogle Scholar
  • 6 Frimberger E. Expanding spiral – a new type of prosthesis for the palliative treatment of malignant esophageal stenosis. Endoscopy 1983; 15: 213-214
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 2001; 344: 1681-1687
    CrossrefPubMedGoogle Scholar
  • 8 Rösch T, Kyrein A, Zillinger C et al. Metal stents in gastroenterology. Chirurg 1999; 70: 868-875
    CrossrefPubMedGoogle Scholar
  • 9 Jain JP. Self-expanding metallic esophageal stents: A long way to go before a particular stent can be recommended. World J Gastroenterol 2011; 17: 5327-5328
    CrossrefPubMedGoogle Scholar
  • 10 Eickhoff A. Möglichkeiten und Grenzen der endoskopischen Stenttherapie mit selbst-expandierenden Metallendoprothesen bei malignen Stenosen des Gastrointestinaltrakts. s.l. Schr 2009;
    PubMedGoogle Scholar
  • 11 Zhu YQ, Cui WG, Cheng YS et al. Biodegradable rapamycin-eluting nano-fiber membrane-covered metal stent placement to reduce fibroblast proliferation in experimental stricture in a canine model. Endoscopy 2013; [Epub ahead of print].
    PubMedGoogle Scholar
  • 12 Repici A, Vleggaar F, Hassan C et al. Efficacy and safety of biodegradable stents for refractory benign esophageal strictures: the BEST (Biodegradable Esophageal Stent) study. Gastrointest Endosc 2011; 5: 927-934
    PubMedGoogle Scholar
  • 13 Freudenberg S, Rewerk S, Bay F et al. Local application of hyperthermia in the esophagus with a heatable malleable thermoplastic stent. Eur Surg Res 2006; 38 (01) 42-47
    CrossrefPubMedGoogle Scholar
  • 14 Dormann AJ, Eisendrath P, Wigginghaus B et al. Palliation of esophageal carcinoma with a new self-expanding plastic stent. Endoscopy 2003; 35: 207-211
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Simmons DT, Baron TH. Endoluminal palliation. Gastrointest Endoscopy Clin N Am 2005; 15: 467-484
    CrossrefPubMedGoogle Scholar
  • 16 van Boeckel PG, Dua KS, Weusten BL et al. Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks. BMC Gastroenterol 2012; 29: 19-23
    PubMedGoogle Scholar
  • 17 Conio M, Repici A, Battaglia G et al. A randomized prospective comparison of self-expandable plastic stents and partially covered self-expandable metal stents in the palliation of malignant esophageal dysphagia. Am J Gastroenterol 2007; 102: 2667-2677
    CrossrefPubMedGoogle Scholar
  • 18 Verschuur EM, Repici A, Kuipers EJ et al. New design esophageal stents for the palliation of Dysphagia from esophageal or gastric cardia cancer: a randomized trial. Am J Gastroenterol 2008; 103: 304-312
    CrossrefPubMedGoogle Scholar
  • 19 Siersema PD, Hop WC, van Blankenstein M et al. A comparison of 3 types of covered metal stents for the palliation of patients with dysphagia caused by esophagogastric carcinoma: a prospective, randomized study. Gastrointest Endosc 2001; 54: 269-272
    CrossrefPubMedGoogle Scholar
  • 20 Homs MY, Steyerberg EW, Kuipers EJ et al. Causes and treatment of recurrent dysphagia after self-expanding metal stent placement for palliation of esophageal carcinoma. Endoscopy 2004; 36: 880-886
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Sabharwal T, Hamady MS, Chui S et al. A randomised prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma. Gut 2003; 52: 922-926
    CrossrefPubMedGoogle Scholar
  • 22 van Boeckel PG, Siersema PD, Sturgess R et al. A new partially covered metal stent for palliation of malignant dysphagia: a prospective follow-up study. Gastrointest Endosc 2010; 72: 1269-1273
    CrossrefPubMedGoogle Scholar
  • 23 Hirdes MM, Siersema PD, Vleggaar FP. new fully covered metal stent for the treatment of benign and malignant dysphagia: a prospective follow-up study. Gastrointest Endosc 2012; 75: 712-718
    CrossrefPubMedGoogle Scholar
  • 24 van Heel NC, Haringsma J, Boot H et al. Comparison of 2 expandable stents for malignant esophageal disease: a randomized controlled trial. Gastrointest Endosc 2012; 76: 52-58
    CrossrefPubMedGoogle Scholar
  • 25 Kim ES, Jeon SW, Park SY et al. Comparison of double-layered and covered Niti-S stents for palliation of malignant dysphagia. J Gastroenterol Hepatol 2009; 24 (01) 114-119
    CrossrefPubMedGoogle Scholar
  • 26 Uitdehaag MJ, van Hooft JE, Verschuur EM. A fully-covered stent (Alimaxx-E) for the palliation of malignant dysphagia: a prospective follow-up study. Gastrointest Endosc 2009; 70 (06) 1082-1085
    CrossrefPubMedGoogle Scholar
  • 27 van Halsema EE, Wong KeeSong LM et al. Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases. Gastrointest Endosc 2013; 77: 18-28
    CrossrefPubMedGoogle Scholar
  • 28 Repici A, Vleggaar FP, Hassan C et al. Efficacy and safety of biodegradable stents for refractory benign esophageal strictures: the BEST (Biodegradable Esophageal Stent) study. Gastrointest Endosc 2010; 72: 927-934
    CrossrefPubMedGoogle Scholar
  • 29 Dormann A, Meisner S, Verin N et al. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 2004; 36 (06) 543-550
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Mittal A, Windsor J, Woodfield J et al. Matched study of three methods for palliation of malignant pyloroduodenal obstruction. Br J Surg 2004; 91: 205-209
    CrossrefPubMedGoogle Scholar
  • 31 Hosono S, Ohtani H, Arimoto Y et al. Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis. J Gastroenterol 2007; 42: 283-290
    CrossrefPubMedGoogle Scholar
  • 32 Jeurnink SM, Steyerberg EW, van Hooft JE. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 2010; 71 (03) 490-499
    CrossrefPubMedGoogle Scholar
  • 33 Isayama H, Sasaki T, Nakai Y. Management of malignant gastric outlet obstruction with a modified triple-layer covered metal stent. Gastrointest Endosc 2012; 75: 757-763
    CrossrefPubMedGoogle Scholar
  • 34 Davids PH, Groen AK, Rauws EA et al. Randomized trial of self-expanding metal stents vs. polyethylene stents for distal malignant biliary obstruction. Lancet 1992; 340: 1488-1492
    CrossrefPubMedGoogle Scholar
  • 35 Moss AC, Morris E, Leyden J et al. Malignant distal biliary obstruction: a systematic review and meta-analysis of endoscopic and surgical bypass results. Cancer Treat Rev 2007; 33: 213-221
    CrossrefPubMedGoogle Scholar
  • 36 Lee JH, Kang DH, Kim JY. Endoscopic bilateral metal stent placement for advanced hilar cholangiocarcinoma: a pilot study of a newly designed Y stent. Gastrointest Endosc 2007; 66: 364-369
    CrossrefPubMedGoogle Scholar
  • 37 Suk KT, Kim JW, Kim HS et al. Human application of a metallic stent covered with a paclitaxel-incorporated membrane for malignant biliary obstruction: multicenter pilot study. Gastrointest Endosc 2007; 66: 798-803
    CrossrefPubMedGoogle Scholar
  • 38 Isayama H, Komatsu Y, Tsujino T. A prospective randomized study of “covered” vs. “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut 2004; 53: 729-734
    CrossrefPubMedGoogle Scholar
  • 39 Kahaleh M, Tokar J, Conaway MR et al. Efficacy and complications of covered Wallstents in malignant distal biliary obstruction. Gastrointest Endosc 2005; 61: 528-533
    CrossrefPubMedGoogle Scholar
  • 40 Wiedmann M, Dietrich A, Mossner J. Combined percutaneous transhepatic biliary drainage with port implantation for management of patients with malignant biliary obstruction. Gastrointest Endosc 2004; 60: 117-120
    CrossrefPubMedGoogle Scholar
  • 41 Binmoeller KF, Weilert F, Shah JN et al. Endosonography-guided transmural drainage of pancreatic pseudocysts using an exchange-free access device: initial clinical experience. Surg Endosc 2013; 27: 1835-1839
    CrossrefPubMedGoogle Scholar
  • 42 Camunez F, Echenagusia A, Simo G et al. Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation. Radiology 2000; 216: 492-497
    CrossrefPubMedGoogle Scholar
  • 43 Sebastian S, Johnston S, Geoghegan T et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 2004; 99: 2051-2057
    CrossrefPubMedGoogle Scholar
  • 44 Tilney HS, Lovegrove RE, Purkayastha S. Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 2007; 21: 225-233
    CrossrefPubMedGoogle Scholar
  • 45 Siddiqui A, Khandelwal N, Anthony T et al. Colonic stent versus surgery for the management of acute malignant colonic obstruction: a decision analysis. Aliment Pharmacol Ther 2007; 26: 1379-1386
    CrossrefPubMedGoogle Scholar
  • 46 Repici A, De Caro G, Luigiano C et al. WallFlex colonic stent placement for management of malignant colonic obstruction: a prospective study at two centers. Gastrointest Endosc 2008; 67: 77-84
    CrossrefPubMedGoogle Scholar
  • 47 Song HY, Kim JH, Shin JH et al. A dual-design expandable colorectal stent for malignant colorectal obstruction: results of a multicenter study. Endoscopy 2007; 39: 448-454
    Article in Thieme ConnectPubMedGoogle Scholar