■ Incision of Strictures
► Incision of the scarred area under endoscopic vision
► Short, annular cicatricial strictures
► Diathermy needle or argon plasma coagulator
► Three or more incisions are made in a stellate pattern under endoscopic vision.
Fig. 4.53 a, b Stent insertion b
■ Self-Expanding Stents
► A small-lumen metal mesh stent is introduced, positioned, and released, expanding to a larger luminal size.
► Malignant strictures of the esophagus
► Treatment of choice for strictures due to inoperable esophageal carcinoma
► 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
► Compression by tumor growth b
Was this article helpful?