Upper Gastrointestinal Stenoses Incision Self Expanding Stents

■ Incision of Strictures

Principle

► Incision of the scarred area under endoscopic vision

Indications

► Short, annular cicatricial strictures

Materials

► Diathermy needle or argon plasma coagulator

Technique

► Three or more incisions are made in a stellate pattern under endoscopic vision.

Complications

► Perforation

Fig. 4.53 a, b Stent insertion b

■ Self-Expanding Stents

Principle

► A small-lumen metal mesh stent is introduced, positioned, and released, expanding to a larger luminal size.

Indications

► Malignant strictures of the esophagus

► Treatment of choice for strictures due to inoperable esophageal carcinoma

Materials

► Stent system. Several types are available, including:

- Strecker stents

- Wall stents

- Coated stents

- Uncoated stents ik

Technique (Figs. 4.53-4.56)

Fig. 4.53 a, b Stent insertion

► Dilate the stricture to 9-10 mm with bougies.

► Place a guide wire through the endoscope, aided if necessary by fluoroscopic monitoring.

► Locate the upper and lower tumor margins endoscopi-cally or radiographically.

► Remove the endoscope.

► Introduce the stent system (stent and applicator) over the guide wire.

► Release the stent (variable mechanism, depending on the design).

Complications (Figs. 4.57, 4.58)

► Failure of stent expansion

► Tumor growth into the stent

► Overgrowth of the ends of the stent

► Dislodgment

► Compression by tumor growth b

Fig. 4.54 Ultraflex stent Fig. 4.55 Upper edge of stent
Fig. 4.56 Overgrown stent

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