Enteral stents

Abstract

Enteral stent placement as a palliative treatment in patients with nonresectable malignant GOO is technically feasible in the vast majority of cases. Moreover, clinical success is achieved in a large number of patients. These two important outcome parameters seem not to be influenced by tumor characteristics, the type of procedure, or the type of stent. Furthermore, the small number of publications which assessed the QoL showed stable or improved results after enteral stent placement. Regarding complications, enteral stenting is generally safe with low rates of severe complications and no reported direct procedure- or stent-related mortality. However, migration and obstruction of enteral stents occur frequently with both of these complications strongly, influencing stent patency. Uncovered stents are associated with a high obstruction rate, while covered stents tend to migrate more regularly. New stent designs have been developed with the aim to overcome these shortcomings, and recent trials with these stents show promising results. There is evidence that stent placement is superior over surgical bypass in terms of rapid improvement of food intake, a shorter hospital stay, less severe complications, and lower medical costs. On the contrary, there is a higher recurrence rate of obstruction after stent placement, subsequently causing more re-interventions. At this moment, we, in general, recommend stent placement, and the option of a surgical bypass has to be considered only in fit patients with a life expectancy of more than 2 months.