Desarrollo e implementación de un nuevo diseño de stent de nitinol para el manejo de estenosis y fístulas benignas del tracto digestivo

Translated title of the contribution: Development and implementation of a new nitinol stent design for managing benign stenoses and fistulas of the digestive tract

Rodrigo Castaño, Oscar Álvarez, Jorge E Lopera, Mario H. Ruiz, Andrés Rojas, Alejandra Álvarez, Luis Miguel Ruiz, David Restrepo

Research output: Contribution to journalArticle

Abstract

Background: Benign stenoses, digestive tract ruptures and fistulas are conditions that endanger life and are often treated surgically. Recently, the placement of partially or fully covered metal stents has emerged as a minimally invasive treatment option. This article looks at a new design for stents to determine its clinical effectiveness. The new stent is a completely covered nitinol stent for treatment of gastrointestinal perforations and anastomotic leaks. This article places special emphasis on evaluating reactive hyperplasia. Methods: Fifteen had the new completely covered self-expanding nitinol stent placed for treatment of benign esophageal perforations, anastomotic leaks, and stenoses following upper or lower gastrointestinal surgery during 2012 and 2013. The stents are 20 mm in diameter in the middle and 28 mm in diameter at the proximal end. Information about patient demographics, type of lesion, lesion locations, stent removal, clinical success and complications was collected. Results: A total of 15 stents were placed in 15 patients to treat anastomotic leaks (n = 8), esophageal stenoses (n = 2), colorectal stenoses (n = 2), a gastrojejunostomy stenosis (n = 1), an esophageal iatrogenic rupture (n = 1), and a pyloric stenosis (n = 1). Endoscopic removal of the stent was successful in all patients. Although it was particularly difficult in one case because of reactive hyperplasia. Clinical success was achieved in nine patients (73%). Average duration of time between stent placement and removal was 10 weeks with a range of 7 to 12 weeks. In total, seven complications occurred in 15 patients (47%): reactive hyperplasia (n = 1), migration (n = 3) severe pain (n = 2) esophageal ulceration (n = 1) only one patient required surgery after stent failure. No patients died as the result of stenting. Conclusions: A redesigned completely covered stent kept in place for 10 weeks may be an alternative to surgery for treating gastrointestinal perforations, anastomotic stenoses and fistulas. The efficacy of the new stent differs from that of conventional stents. The choice depends on the expected risks of stent migration and reactive hyperplasia.

Original languageSpanish
Pages (from-to)261-272
Number of pages12
JournalRevista Colombiana de Gastroenterologia
Volume30
Issue number3
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Fistula
Stents
Gastrointestinal Tract
Pathologic Constriction
Anastomotic Leak
Hyperplasia
nitinol
Rupture
Pyloric Stenosis
Esophageal Perforation
Esophageal Stenosis
Gastric Bypass
Therapeutics
Metals
Demography

Keywords

  • Benign stenosis
  • Esophageal perforation
  • Gastrointestinal fistula
  • Metal stent
  • Nitinol

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Castaño, R., Álvarez, O., Lopera, J. E., Ruiz, M. H., Rojas, A., Álvarez, A., ... Restrepo, D. (2015). Desarrollo e implementación de un nuevo diseño de stent de nitinol para el manejo de estenosis y fístulas benignas del tracto digestivo. Revista Colombiana de Gastroenterologia, 30(3), 261-272.

Desarrollo e implementación de un nuevo diseño de stent de nitinol para el manejo de estenosis y fístulas benignas del tracto digestivo. / Castaño, Rodrigo; Álvarez, Oscar; Lopera, Jorge E; Ruiz, Mario H.; Rojas, Andrés; Álvarez, Alejandra; Ruiz, Luis Miguel; Restrepo, David.

In: Revista Colombiana de Gastroenterologia, Vol. 30, No. 3, 01.01.2015, p. 261-272.

Research output: Contribution to journalArticle

Castaño, R, Álvarez, O, Lopera, JE, Ruiz, MH, Rojas, A, Álvarez, A, Ruiz, LM & Restrepo, D 2015, 'Desarrollo e implementación de un nuevo diseño de stent de nitinol para el manejo de estenosis y fístulas benignas del tracto digestivo', Revista Colombiana de Gastroenterologia, vol. 30, no. 3, pp. 261-272.
Castaño, Rodrigo ; Álvarez, Oscar ; Lopera, Jorge E ; Ruiz, Mario H. ; Rojas, Andrés ; Álvarez, Alejandra ; Ruiz, Luis Miguel ; Restrepo, David. / Desarrollo e implementación de un nuevo diseño de stent de nitinol para el manejo de estenosis y fístulas benignas del tracto digestivo. In: Revista Colombiana de Gastroenterologia. 2015 ; Vol. 30, No. 3. pp. 261-272.
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abstract = "Background: Benign stenoses, digestive tract ruptures and fistulas are conditions that endanger life and are often treated surgically. Recently, the placement of partially or fully covered metal stents has emerged as a minimally invasive treatment option. This article looks at a new design for stents to determine its clinical effectiveness. The new stent is a completely covered nitinol stent for treatment of gastrointestinal perforations and anastomotic leaks. This article places special emphasis on evaluating reactive hyperplasia. Methods: Fifteen had the new completely covered self-expanding nitinol stent placed for treatment of benign esophageal perforations, anastomotic leaks, and stenoses following upper or lower gastrointestinal surgery during 2012 and 2013. The stents are 20 mm in diameter in the middle and 28 mm in diameter at the proximal end. Information about patient demographics, type of lesion, lesion locations, stent removal, clinical success and complications was collected. Results: A total of 15 stents were placed in 15 patients to treat anastomotic leaks (n = 8), esophageal stenoses (n = 2), colorectal stenoses (n = 2), a gastrojejunostomy stenosis (n = 1), an esophageal iatrogenic rupture (n = 1), and a pyloric stenosis (n = 1). Endoscopic removal of the stent was successful in all patients. Although it was particularly difficult in one case because of reactive hyperplasia. Clinical success was achieved in nine patients (73{\%}). Average duration of time between stent placement and removal was 10 weeks with a range of 7 to 12 weeks. In total, seven complications occurred in 15 patients (47{\%}): reactive hyperplasia (n = 1), migration (n = 3) severe pain (n = 2) esophageal ulceration (n = 1) only one patient required surgery after stent failure. No patients died as the result of stenting. Conclusions: A redesigned completely covered stent kept in place for 10 weeks may be an alternative to surgery for treating gastrointestinal perforations, anastomotic stenoses and fistulas. The efficacy of the new stent differs from that of conventional stents. The choice depends on the expected risks of stent migration and reactive hyperplasia.",
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