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Review
. 2018 Nov;91(1091):20170935.
doi: 10.1259/bjr.20170935. Epub 2018 Jun 27.

Oesophageal stenting: Status quo and future challenges

Harry Kaltsidis  1 , Wasat Mansoor  2 , Jung-Hoon Park  3 , Ho-Young Song  3 , Derek William Edwards  4   5 , Hans-Ulrich Laasch  4   5
Affiliations
Review

Oesophageal stenting: Status quo and future challenges

Harry Kaltsidis et al. Br J Radiol. 2018 Nov.

Abstract

Oesophageal stents are widely used for palliating dysphagia from malignant obstruction. They are also used with increasing frequency in the treatment of oesophageal perforation, as well as benign strictures from a variety of causes. Improved oncological treatments have led to prolonged survival of patients treated with palliative intent; as a consequence, stents need to function and last longer in order to avoid repeat procedures. There is also increasing need for meticulous procedure planning, careful selection of the device most appropriate for the individual patient and planned follow-up. Furthermore, as more patients are cured, there will be more issues with resultant long-term side-effects, such as recalcitrant strictures due to radiotherapy or anastomotic scarring, which will have to be addressed. Stent design needs to keep up with the progress of cancer treatment, in order to offer patients the best possible long-term result. This review article attempts to illustrate the changing realities in oesophageal stenting, differences in current stent designs and behaviour, as well as the pressing need to refine and modify devices in order to meet the new challenges.

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Figures

Figure 1.
Figure 1.
Different oesophageal stents (from left): Laser-cut EndoMaxx stent (Merit), Braided Evolution stent (Cook), Knitted Egis stent (S&G Biotech).
Figure 2.
Figure 2.
Anti-migration stents: (top) Ella-HV plus (Ella-CS) with anchoring collar (arrowheads), (bottom) Niti-S double stent (TaeWoong Medical) with bare fixation segment (arrow).
Figure 3.
Figure 3.
Conformability of a knitted stent (Egis, S&G Biotech).
Figure 4.
Figure 4.
Ella Seal stent (Ella-CS) for benign perforations, also licensed for compressing variceal haemorrhage (Danis version). Note the varying braiding angle.
Figure 5.
Figure 5.
(Straight) Partially covered, double knitted colonic stents; (left) Egis (S&G Biotech); (right) ComVi (Taewoong Medical).
Figure 6.
Figure 6.
Biodegradable Ella-SX BD oesophageal stent (Ella-CS).
Figure 7.
Figure 7.
(A) Radiograph showing irregular widening of a stent with angulation of the distal head (arrow) indicating degradation of the nitinol. (B) Axial CT showing disintegration of the intragastric stent portion and dislocation of the distal head (arrow). (C) Endoscopy images show wire fractures (arrowhead), which precluded stent removal and a guide wire (arrow) inserted for secondary stenting (top). Inspection of the stomach after further stent insertion demonstrates the stent fragment in the stomach (bottom). (D) Fluoroscopic image showing the coaxial Ella-HV rescue stent, as well as the distal fragment (arrow).
Figure 8.
Figure 8.
Montage of 2 sagittal CT reconstructions acquired in a supine position showing the stomach content (S) emptying through the distal end of an open stent (arrow) freely into the upper oesophagus (arrowheads).
Figure 9.
Figure 9.
Different types of valved oesophageal stents (from left): Ella HV plus (Ella-CS), Egis (S&G Biotech), Niti-S (TaeWoong Medical), Hanaro (MI Tech).
See this image and copyright information in PMC

References

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