History of GI stenting: Rigid prostheses in the esophagus

Abstract

The evolution of esophageal stents has gone through stages over the last 125 years. Prior to the development of esophageal stents, surgery was the only option for relief of dysphagia due to esophageal cancer. Gastrostomy tube placement provided palliation for nourishment and hydration but did nothing for relief of dysphagia; some patients survived long enough to ultimately lose the ability to swallow secretions. Endoesophageal tubes (external-internal) were initially placed to provide nutrition without the need for surgery but again did not restore swallowing ability. Sir Charters Symonds was the first to successfully place an esophageal prosthesis across a malignant stricture. Although there were many modifications of rigid esophageal stents in which various materials (wood, metal, plastic, latex) and designs were used, it was not until Celestin designed a new prosthesis and, following its commercial availability in the 1970s, did the stent revolution accelerate. There were competing technologies, mainly Nd-YAG laser ablation for neolumen creation, and administration of radiation and chemotherapy. The rigid prosthesis (plastic and latex) was extensively used from the 1970s to the 1990s, but the complication rates and mortality associated with insertion-related perforations remained significant. In the early 1990s, self-expandable metal stents (SEMS) were developed for esophageal use a decade after their introduction into the vascular and biliary tree. Esophageal SEMS led to rapid and durable relief of dysphagia and became the primary modality for palliation of malignant dysphagia.