353:
153:
282:
316:
usually placed on the surface of the patient to mark the area of narrowing on fluoroscopy. The SEMS is placed through the channel of the endoscope into the esophagus over a guidewire, marked on fluoroscopy, and mechanically deployed (using a device that sits outside of the endoscope) such that it expands when in position.
383:
Long-term complications of SEMS may be related to the underlying tumour being treated: the tumour may grow into the stent wall (tumour ingrowth) or over the end of the stent (tumour overgrowth), leading to obstruction. These complications may be limited by the use of coated stents. Tumour ingrowth or
1007:
Garcia-Cano J; Gonzalez-Huix F; Juzgado D; Igea F; Perez-Miranda M; Lopez-Roses L; Rodriguez A; Gonzalez-Carro P; Yuguero L; Espinos J; Ducons J; Orive V; Rodriguez S. (2006). "Use of self-expanding metal stents to treat malignant colorectal obstruction in general endoscopic practice (with videos)".
160:
Self-expandable metallic stents are cylindrical in shape, and are devised in a number of diameters and lengths to suit the application in question. They typically consist of cross-hatched, braided or interconnecting rows of metal that are assembled into a tube-like structure. SEMS, when unexpanded,
315:
Esophageal SEMS are placed after a gastroscopy is performed to identify the area of narrowing. The area may need to be dilated to allow the gastroscope to pass. The tumour is usually better seen with the direct vision of endoscopy than on a fluoroscopic image. As a result, radio-opaque markers are
246:
caused by esophageal reflux and perforations of the esophagus. SEMS may also be placed in tandem fashion to treat ingrowth or overgrowth tumours, and fractures or migration of other SEMS. For the latter, the second SEMS in usually deployed within the lumen of the first.
1043:
Vakil N, Morris A, Marcon N, Segalin A, Peracchia A, Bethge N, Zuccaro G, Bosco J, Jones W (2001). "A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction".
198:) has also been developed for similar applications. It confers an additional advantage as it is designed to be removable, and may have a less traumatic insertion than metal stents. The Polyflex stent has shown benefit in palliation of esophageal malignancies.
399:
Over time, SEMS may also migrate to a different position that does not help with treatment of the obstructed area. This may be treated with placement of a second SEMS, or endoscopic attempts to reposition or remove the first. Rarely, SEMS may fracture or
210:
of tumours that obstruct the gastrointestinal tract. When they expand within the lumen, they are able to hold open the structure and allow passage of material, such as food, stool, or other secretions. The usual applications are for cancers of the
490:
Schmassmann A, Meyenberger C, Knuchel J, Binek J, Lammer F, Kleiner B, Hürlimann S, Inauen W, Hammer B, Scheurer U, Halter F (1997). "Self-expanding metal stents in malignant esophageal obstruction: a comparison between two stent types".
26:
518:
Song H, Park S, Jung H, Kim S, Kim J, Huh S, Kim T, Kim Y, Park S, Yoon H, Sung K, Min Y (1997). "Benign and malignant esophageal strictures: treatment with a polyurethane-covered retrievable expandable metallic stent".
165:, which is meant for delivery of devices for therapeutic endoscopy. They expand through a deployment device placed at the end of the SEMS, and are held in place against the wall of the luminal surface by friction.
320:
or other water-soluble dye may be placed through the passage to ensure patency of the stent on fluoroscopy. Enteric and colonic SEMS are inserted in a similar fashion, but in the duodenum and colon respectively.
730:
Fiorini A, Fleischer D, Valero J, Israeli E, Wengrower D, Goldin E (2000). "Self-expandable metal coil stents in the treatment of benign esophageal strictures refractory to conventional therapy: a case series".
1143:"Iatrogenic intussusception of a self-expanding metallic esophageal stent in stent after endoscopic guidewire trauma. Abstract presented at Canadian Association of Gastroenterology Meetings, February 2006"
936:
Schiefke I, Zabel-Langhennig A, Wiedmann M, Huster D, Witzigmann H, Mössner J, Berr F, Caca K (2003). "Self-expandable metallic stents for malignant duodenal obstruction caused by biliary tract cancer".
766:
Gelbmann C, Ratiu N, Rath H, Rogler G, Lock G, Schölmerich J, Kullmann F (2004). "Use of self-expandable plastic stents for the treatment of esophageal perforations and symptomatic anastomotic leaks".
598:
Ell C, Hochberger J, May A, Fleig W, Hahn E (1994). "Coated and uncoated self-expanding metal stents for malignant stenosis in the upper GI tract: preliminary clinical experiences with
Wallstents".
191:
are typically used as coatings for SEMS. Covered stents carry the advantage of preventing tumours from growing into the stent, although they run the risk of increased migration after deployment.
554:
Saxon R, Morrison K, Lakin P, Petersen B, Barton R, Katon R, Keller F (1997). "Malignant esophageal obstruction and esophagorespiratory fistula: palliation with a polyethylene-covered Z-stent".
901:
Ramirez F, Dennert B, Zierer S, Sanowski R (1997). "Esophageal self-expandable metallic stents--indications, practice, techniques, and complications: results of a national survey".
625:
Decker P, Lippler J, Decker D, Hirner A (2001). "Use of the
Polyflex stent in the palliative therapy of esophageal carcinoma: results in 14 cases and review of the literature".
1106:
Matsushita M, Takakuwa H, Nishio A, Kido M, Shimeno N (2003). "Open-biopsy-forceps technique for endoscopic removal of distally migrated and impacted biliary metallic stents".
972:
Yoon W, Lee J, Lee K, Lee W, Ryu J, Kim Y, Yoon Y (2006). "A comparison of covered and uncovered
Wallstents for the management of distal malignant biliary obstruction".
312:
images taken to guide placement. Prior to the development of SEMS small enough to pass through the channel of the endoscopy, SEMS were deployed using fluoroscopy alone.
695:
Holt A, Patel M, Ahmed M (2004). "Palliation of patients with malignant gastroduodenal obstruction with self-expanding metallic stents: the treatment of choice?".
455:
Mauro M, Koehler R, Baron T (2000). "Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents".
329:
242:
SEMS and self-expanding plastic stents have also been used for non-malignant conditions that cause narrowing or leaks of the esophagus or colon. These include
806:
Yoshida H, Mamada Y, Taniai N, Mizuguchi Y, Shimizu T, Aimoto T, Nakamura Y, Nomura T, Yokomuro S, Arima Y, Uchida E, Misawa H, Uchida E, Tajiri T (2006).
144:
and colon. SEMS are designed to be permanent and, as a result, are often used when the cancer is at an advanced stage and cannot be removed by surgery.
364:
The complications of SEMS are related to a number of factors. The first is that the endoscopic procedure used to insert a SEMS involves the use of
340:
that is located at its base is typically cut. A wire is kept in the bile duct, and the SEMS is deployed over the wire in a similar fashion as
847:
Kauffmann G, Roeren T, Friedl P, Brambs H, Richter G (1990). "Interventional radiological treatment of malignant biliary obstruction".
401:
270:
660:
Nelson D, Silvis S, Ansel H (1994). "Management of a tracheoesophageal fistula with a silicone-covered self-expanding metal stent".
243:
132:
of the gastrointestinal tract that obstruct the interior of the tube-like (or luminal) structures of the bowel — namely the
1172:
1071:
Conio M, Gostout C (1998). "Photodynamic therapy for the treatment of tumor ingrowth in expandable esophageal stents".
874:
Cordero J, Moores D (2000). "Self-expanding esophageal metallic stents in the treatment of esophageal obstruction".
384:
overgrowth can be additionally palliated by the placement of a second stent through the lumen of the first, through
259:
232:
1167:
228:
389:
227:
that are not amenable to surgical therapy. SEMS are used to treat additional complications of cancer, such as
808:"Fracture of an expandable metallic stent placed for biliary obstruction due to common bile duct carcinoma"
168:
SEMS may be coated with chemicals designed to prevent tumour ingrowth; these are termed "covered" stents.
86:
393:
369:
263:
768:
332:, a procedure that uses endoscopy and fluoroscopy to access the common bile duct. The bile duct is
324:
Biliary SEMS are used to palliatively treat tumours of the pancreas or bile duct that obstruct the
220:
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where the surgeon uses an X-ray image to guide insertion, or as an adjunct to endoscopy.
468:
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420:
Vitale G, Davis B, Tran T (2005). "The advancing art and science of endoscopy".
377:
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285:
156:
Schematic of self-expandable metallic stent used to treat vascular abnormalities
122:
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Self-expandable metallic stents are typically inserted at the time of
25:
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The vast majority of SEMS are used to alleviate symptoms caused by
351:
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of the bowel or compression of structures adjacent to the bowel.
360:. The large black tube across the image is the duodenoscope.
392:
of the tumour tissue in the stent, or through the use of
117:—to reach an area of narrowing. As such, it is termed an
344:. The location of the SEMS is confirmed by fluoroscopy.
356:
Fluoroscopic image of two metal biliary stents in the
1141:Grover SC, Wang CS, Jones MB, Elyas ME, Kortan PP.
50:
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161:are small enough to fit through the channel of an
368:medications, which may lead to oversedation,
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336:with the assistance of a guidewire and the
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206:The primary application of SEMS is in the
194:A plastic self-expanding stent (Polyflex,
24:
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412:
262:. In the past they have been used for
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587:
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250:SEMS are also sometimes used in the
376:. SEMS also expand and can lead to
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271:percutaneous coronary interventions
85:that holds open a structure in the
59:
469:10.1148/radiology.215.3.r00jn30659
239:, duodenal, or pancreatic cancer.
121:. SEMS can also be inserted using
14:
97:, or other secretions related to
812:Journal of Nippon Medical School
882:(10): 956–8, discussion 958–9.
568:10.1148/radiology.202.2.9015055
533:10.1148/radiology.203.3.9169699
404:after endoscopic intervention.
304:, usually with assistance with
290:metallic stent in the esophagus
89:to allow the passage of food,
75:self-expandable metallic stent
32:self-expandable metallic stent
19:Self-expandable metallic stent
1:
1120:10.1016/S0016-5107(03)02335-6
1085:10.1016/S0016-5107(98)70175-0
915:10.1016/S0016-5107(97)70144-5
709:10.1016/S0016-5107(04)02276-X
674:10.1016/S0016-5107(94)70221-7
434:10.1016/j.amjsurg.2005.05.017
231:from esophageal cancer, and
1189:
260:peripheral vascular system
233:gastric outlet obstruction
229:tracheoesophageal fistulas
109:camera—either through the
101:. Surgeons insert SEMS by
1022:10.1016/j.gie.2006.06.034
986:10.1016/j.gie.2005.11.054
288:image of self-expandable
148:Composition and structure
81:) is a metallic tube, or
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23:
390:argon plasma coagulation
296:used to place the stent.
745:10.1067/mge.2000.107709
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87:gastrointestinal tract
782:10.1055/s-2004-825656
639:10.1007/s004640090099
355:
284:
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30:Endoscopic view of a
951:10.1067/mge.2003.362
394:photodynamic therapy
264:saphenous vein graft
34:used to palliate an
1173:Implants (medicine)
1108:Gastrointest Endosc
1073:Gastrointest Endosc
1010:Gastrointest Endosc
974:Gastrointest Endosc
939:Gastrointest Endosc
903:Gastrointest Endosc
825:10.1272/jnms.73.164
733:Gastrointest Endosc
697:Gastrointest Endosc
662:Gastrointest Endosc
1046:Am J Gastroenterol
600:Am J Gastroenterol
493:Am J Gastroenterol
362:
298:
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342:esophageal stents
338:sphincter of Oddi
254:, usually in the
244:peptic strictures
196:Boston Scientific
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36:esophageal cancer
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1168:Gastroenterology
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306:fluoroscopy
266:and native
123:fluoroscopy
107:fibre optic
43:Other names
1162:Categories
1148:2006-12-07
1079:(2): 225.
408:References
370:aspiration
334:cannulated
277:Deployment
221:bile ducts
208:palliation
769:Endoscopy
556:Radiology
521:Radiology
457:Radiology
422:Am J Surg
302:endoscopy
294:endoscope
213:esophagus
163:endoscope
134:esophagus
103:endoscopy
99:digestion
52:Specialty
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183:alloy),
181:titanium
138:duodenum
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682:7523233
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318:Hypaque
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438:PMID
330:ERCP
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