Gastroduodenal Stent-Related Complications and Management

Abstract

Placement of a gastroduodenal self-expandable metallic stent (SEMS) is a safe and well-established procedure for the palliative care of malignant gastric outlet obstruction. There have been reported complications related to the SEMS procedure such as stent occlusion, migration of the stent, biliary obstruction, bleeding, and bowel perforation. Early detection and proper management of the complications are crucial to maintain the quality of life and prolong the life expectancy of the patients. In this article, we will discuss the diagnosis and treatment of SEMS-related complications.

Keywords

complications - gastric outlet obstruction - self-expandable metallic stent

• References

• 1 Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 2001; 344 (22) 1681-1687
• 2 Katsanos K, Sabharwal T, Adam A. Stenting of the upper gastrointestinal tract: current status. Cardiovasc Intervent Radiol 2010; 33 (04) 690-705
• 3 Kim JH, Song HY, Shin JH. , et al. Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients. Gastrointest Endosc 2007; 66 (02) 256-264
• 4 Lopera JE, Brazzini A, Gonzales A, Castaneda-Zuniga WR. Gastroduodenal stent placement: current status. Radiographics 2004; 24 (06) 1561-1573
• 5 Oh SY, Edwards A, Mandelson M. , et al. Survival and clinical outcome after endoscopic duodenal stent placement for malignant gastric outlet obstruction: comparison of pancreatic cancer and nonpancreatic cancer. Gastrointest Endosc 2015; 82 (03) 460-8.e2
• 6 Tringali A, Didden P, Repici A. , et al. Endoscopic treatment of malignant gastric and duodenal strictures: a prospective, multicenter study. Gastrointest Endosc 2014; 79 (01) 66-75
• 7 Yoon CJ, Song HY, Shin JH. , et al. Malignant duodenal obstructions: palliative treatment using self-expandable nitinol stents. J Vasc Interv Radiol 2006; 17 (2 Pt 1): 319-326
• 8 Dormann A, Meisner S, Verin N, Wenk Lang A. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 2004; 36 (06) 543-550
• 9 Kim CG, Choi IJ, Lee JY. , et al. Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: a randomized, prospective study. Gastrointest Endosc 2010; 72 (01) 25-32
• 10 Kim JH, Song HY, Shin JH. , et al. Membrane degradation of covered stents in the upper gastrointestinal tract: frequency and clinical significance. J Vasc Interv Radiol 2008; 19 (2 Pt 1): 220-224
• 11 Kim JH, Song HY, Shin JH. , et al. Stent collapse as a delayed complication of placement of a covered gastroduodenal stent. AJR Am J Roentgenol 2007; 188 (06) 1495-1499
• 12 Kim JH, Song HY, Shin JH. , et al. Metallic stent placement in the palliative treatment of malignant gastric outlet obstructions: primary gastric carcinoma versus pancreatic carcinoma. AJR Am J Roentgenol 2009; 193 (01) 241-247
• 13 Chhetri SK, Selinger CP, Greer S. Fracture of an esophageal stent: a rare but significant complication. Endoscopy 2008; 40 (Suppl. 02) E199
• 14 Goenka AH, Garg PK, Sharma R, Sharma B. Spontaneous fracture of an uncovered enteral stent with proximal migration of fractured segment into cervical esophagus: first report. Endoscopy 2009; 41 (Suppl. 02) E204-E205
• 15 Rana SS, Bhasin DK, Sidhu GS, Rawal P, Nagi B, Singh K. Esophageal nitinol stent dysfunction because of fracture and collapse. Endoscopy 2009; 41 (Suppl. 02) E170-E171
• 16 Kang MK, Song HY, Kim JW. , et al. Additional gastroduodenal stent placement: retrospective evaluation of 68 consecutive patients with malignant gastroduodenal obstruction. Acta Radiol 2013; 54 (08) 944-948
• 17 Kim CG, Choi IJ, Lee JY. , et al. Outcomes of second self-expandable metallic stent insertion for malignant gastric outlet obstruction. Surg Endosc 2014; 28 (01) 281-288
• 18 Sasaki T, Isayama H, Nakai Y. , et al. Clinical outcomes of secondary gastroduodenal self-expandable metallic stent placement by stent-in-stent technique for malignant gastric outlet obstruction. Dig Endosc 2015; 27 (01) 37-43
• 19 Park JC, Park JJ, Cheoi K. , et al. Clinical outcomes of secondary stent-in-stent self-expanding metal stent placement for primary stent malfunction in malignant gastric outlet obstruction. Dig Liver Dis 2012; 44 (12) 999-1005
• 20 Jung GS, Song HY, Kang SG. , et al. Malignant gastroduodenal obstructions: treatment by means of a covered expandable metallic stent-initial experience. Radiology 2000; 216 (03) 758-763
• 21 Mauro MA, Koehler RE, Baron TH. Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents. Radiology 2000; 215 (03) 659-669
• 22 Morgan R, Adam A. Use of metallic stents and balloons in the esophagus and gastrointestinal tract. J Vasc Interv Radiol 2001; 12 (03) 283-297
• 23 Maetani I, Ukita T, Tada T, Shigoka H, Omuta S, Endo T. Metallic stents for gastric outlet obstruction: reintervention rate is lower with uncovered versus covered stents, despite similar outcomes. Gastrointest Endosc 2009; 69 (04) 806-812
• 24 Jung GS, Song HY, Seo TS. , et al. Malignant gastric outlet obstructions: treatment by means of coaxial placement of uncovered and covered expandable nitinol stents. J Vasc Interv Radiol 2002; 13 (03) 275-283
• 25 Park HS, Do YS, Suh SW. , et al. Upper gastrointestinal tract malignant obstruction: initial results of palliation with a flexible covered stent. Radiology 1999; 210 (03) 865-870
• 26 Lopera JE, Alvarez O, Castaño R, Castañeda-Zuñiga W. Initial experience with Song's covered duodenal stent in the treatment of malignant gastroduodenal obstruction. J Vasc Interv Radiol 2001; 12 (11) 1297-1303
• 27 Lee H, Min BH, Lee JH. , et al. Covered metallic stents with an anti-migration design vs. uncovered stents for the palliation of malignant gastric outlet obstruction: a multicenter, randomized trial. Am J Gastroenterol 2015; 110 (10) 1440-1449
• 28 Ko HK, Song HY, Shin JH, Lee GH, Jung HY, Park SI. Fate of migrated esophageal and gastroduodenal stents: experience in 70 patients. J Vasc Interv Radiol 2007; 18 (06) 725-732
• 29 Kim SY, Song HY, Kim JH. , et al. Bridging across the ampulla of Vater with covered self-expanding metallic stents: is it contraindicated when treating malignant gastroduodenal obstruction?. J Vasc Interv Radiol 2008; 19 (11) 1607-1613
• 30 Baron TH, Wong Kee Song LM, Zielinski MD, Emura F, Fotoohi M, Kozarek RA. A comprehensive approach to the management of acute endoscopic perforations (with videos). Gastrointest Endosc 2012; 76 (04) 838-859
• 31 Small AJ, Petersen BT, Baron TH. Closure of a duodenal stent-induced perforation by endoscopic stent removal and covered self-expandable metal stent placement (with video). Gastrointest Endosc 2007; 66 (05) 1063-1065