Gastrointestinal stent placement was introduced at the end of the nineteenth century when it was performed in patients who had a malignant oesophageal obstruction.1 Nowadays, gastrointestinal stents are placed for multiple indications, such as oesophageal stenosis (Figure 1), gastric outlet obstruction (Figure 2) and colonic stenosis (Figure 3).
Palliation of dysphagia caused by a malignant tumour is the most common indication for stent placement in the oesophagus. However, benign oesophageal strictures are occasionally also treated by stenting because circular ulceration can result in the formation of additional oesophageal strictures and dysphagia.2 Other oesophageal indications include perforations, fistulas, and anastomotic leaks or strictures that can arise after oesophagectomy or bariatric surgery.3 Stent placement in the distal stomach or duodenum is frequently performed for palliation of malignant gastric outlet obstruction. In Western countries, gastric outlet obstruction is most frequently caused by pancreatic cancer, whereas in Asia it occurs more often in patients who have gastric cancer.4–6 Regarding colonic stent placement, it is important to realize that 8–13% of colorectal cancer patients present with acute intestinal obstruction, which in the past was always treated with emergency surgery.7 As multiple studies demonstrated high mortality and morbidity rates after such emergency surgery, colonic stent placement was introduced as a bridge to elective tumour resection.8–11 Finally, for nonoperable patients who have an ileus caused by colonic cancer, stents are also used for palliation.
Although similar-looking stents are used in the oesophagus, distal stomach/duodenum and colon, it should be emphasized that the diseases occurring in these locations are different entities and should be treated in different ways. Here, we discuss frequent mistakes that can be made during gastrointestinal stent placement, based on the literature and the authors’ clinical experience.
Figure 1 | Oesophageal stent obstruction. a | Stent obstruction caused by food stasis. b | Stent obstruction caused by distal migration of an oesophageal stent. Images courtesy of Amsterdam UMC, University of Amsterdam.
Figure 2 | Duodenal stent placement. a and b | Placement of a stent in the duodenum of a patient with gastric outlet obstruction caused by an irresectable pancreatic cancer. Images courtesy of Amsterdam UMC, University of Amsterdam.
Figure 3 | Colonic stent placement. a and b | Placement of a stent in the colon of a patient with an obstructing colonic cancer. Images courtesy of Amsterdam UMC, University of Amsterdam.