Futuristic Developments and Applications in Endoluminal Stenting

Abstract

Endoscopic stenting is a well-established option for the treatment of malignant obstruction, temporary management of benign strictures, and sealing transmural defects, as well as drainage of pancreatic fluid collections and biliary obstruction. In recent years, in addition to expansion in indications for endoscopic stenting, considerable strides have been made in stent technology, and several types of devices with advanced designs and materials are continuously being developed. In this review, we discuss the important developments in stent designs and novel indications for endoluminal and transluminal stenting. Our discussion specifically focuses on (i) biodegradable as well as (ii) irradiating and drug-eluting stents for esophageal, gastroduodenal, biliary, and colonic indications, (iii) endoscopic stenting in inflammatory bowel disease, and (iv) lumen-apposing metal stent.

Figure 1

(a, b) Endoscopic images of a patient with a refractory caustic esophageal stricture who underwent placement of a 25/20/25 × 100 mm biodegradable noncovered stent. (c, d) Endoscopic images of a patient with an esophageal-jejunal anastomotic leak who underwent placement of a 28/23/28 × 100 mm biodegradable fully covered stent, covering the leak.

Figure 2

Patient with a mediastinal collection adjacent to the esophagus. (a) Endosonographic image showing deployment of a 10 mm diameter lumen apposing metal stent (LAMS). (b) Endoscopic image of the proximal flange placed in the esophagus. (c) Endoscopic image of the esophageal defect after LAMS removal. (d) Endoscopic image of the esophageal defect closed with endoclips.

Figure 3

Patient with a previous Roux-en-Y gastric bypass who presented with jaundice secondary to pancreatic cancer underwent endoscopic ultrasound directed transgastric ERCP (EDGE). (a) Fluoroscopic image showing a 20 mm diameter lumen apposing metal stent (LAMS) placed between the gastric pouch and the gastric remnant under EUS guidance. (b) Endoscopic image of the proximal flange of the LAMS in the gastric pouch.

Figure 4

Patient with a refractory esophago-jejunal anastomotic stricture who underwent placement of lumen apposing metal stent (LAMS) across the stricture. (a, b) Endoscopic image of the LAMS placed across the stricture. (c) Esophago-jejunal anastomotic stricture remodelling after LAMS removal.