History of self-expandable metal and self-expandable plastic stent development

Abstract

The first self-expandable metal stent (SEMS) for biliary use was devised by Gianturco and reported by Wright et al. in 1985. The Gianturco Z-stent was made of stainless steel wire bent into a zigzag pattern with connected ends. It was compressed and introduced through a Teflon sheath of 8-12 French depending on the wire caliber and the diameter of the stent. Since then, many investigators have devised different kinds of SEMS for the biliary system and the gastrointestinal tract and one self-expandable plastic stent (SEPS) for esophageal use. SEMS have been found to be effective for relief of esophageal, gastroduodenal, colonic, and biliary obstructions, either palliatively or as a bridge to surgical resection, in patients with primary or metastatic cancer. SEPS have been used for palliation of esophageal obstruction and fistula but are approved for benign esophageal disease and removal. In recent years, indications for placement of a SEMS have been extended to patients with benign biliary, esophageal, and gastrointestinal strictures when patients have failed balloon dilation therapy. The purpose of this chapter is to review the history of SEMS/SEPS development in the biliary system and the gastrointestinal tract.