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Self-Expandable Stents
in the Gastrointestinal Tract

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Richard Kozarek Todd Baron
Ho-Young Song
Editors
Self-Expandable Stents in the Gastrointestinal Tract

Editors
Richard Kozarek
Digestive Disease Institute
Virginia Mason Medical Center
and University of Washington
Seattle, WA 98111, USA
Ho-Young Song
Department of Radiology
Asan Medical Center
388-1 Pungnap-2 Dong
Songpa-Gu, Seoul 138-736
Korea, Republic of (South Korea)
Todd Baron
Division of Gastroenterology
and Hepatology
Mayo Clinic College of Medicine
Rochester, MN 55905, USA
ISBN 978-1-4614-3745-1 ISBN 978-1-4614-3746-8 (eBook)
DOI 10.1007/978-1-4614-3746-8
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2012940930
© Springer Science+Business Media New York 2013
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of
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The use of general descriptive names, registered names, trademarks, service marks, etc. in this
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While the advice and information in this book are believed to be true and accurate at the date of
publication, neither the authors nor the editors nor the publisher can accept any legal responsibility
for any errors or omissions that may be made. The publisher makes no warranty, express or
implied, with respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)

Preface
Historically, nonsurgical reconstitution of the gut lumen was limited to the
placement of rigid tubes in unresectable esophageal cancer. Initially fashioned
out of boxwood or ivory, they were fi xed into place by suture tied to a handlebar
mustache or looped around the ears. Later they were fashioned out of a compound used by British dentist, Charles T. Stent (1807–1885), who initially
developed it to create dental impressions. These conduits ultimately were called
stents, a term that fi rst appeared in the medical literature in 1952.
Rigid biliary prostheses (stents) were fi rst placed surgically in the mid1950s, and the fi rst percutaneous placement was described by Molnar and
Stockum approximately two decades later. A mere 5 years later, in 1979,
Reynders-Fredrix and Soehendra described the fi rst endoscopic placement of
a 7 Fr plastic stent in the biliary tree, although it took almost another decade
to routinely place small diameter prostheses into the pancreas and to produce
endoscopes with a channel size large enough to place 10–11.5 Fr stents.
Self-expandable metal stents (SEMS), placed through a small diameter
delivery system and which conform to the body’s angulations, have allowed
additional anatomical areas to be bypassed, decreased risks associated with
placement of relatively large diameter plastic tubes through natural ori fi ces,
and have expanded our ability to palliate and effectively treat a wide variety
of GI disorders, benign as well as malignant. Their development and application has been nothing short of revolutionary in the treatment of malignant,
and to a lesser extent, noncancerous stenoses and acute and chronic GI tract
leaks and perforations.
This is the context of our text, Self-Expandable Stents in the Gastrointestinal
Tract . It brings together the world’s experts in stent design and placement,
including polyethylene (plastic) prostheses, and a variety of expandable stents
(metal, silicone, and absorbable/polylactide ). It also brings together the disciplines with the greatest experience in their use in the GI tract: therapeutic
endoscopists and interventional radiologists.
This book covered the state of the art in a rapidly changing technology.
Despite this evolution, however, and the fact that the FDA and its equivalent in
other countries, de fi nes ultimate product availability, basic physics and the
design of expandable prostheses are crucial in de fi ning current and future devices
and their applications. Although de fi ned historically and anatomically throughout the text, this distinction is arti fi cial and is limited by anatomic access, either
percutaneously or by the current use of natural ori fi ces (mouth and anus). The
v

vi
ability to deliver these prostheses by endoscopic ultrasound to straddle the inner
and outer wall of the GI tract has revolutionized our ability to drain extraluminal
fl uid collections and perform anastomoses to include gastrojejunostomy, cholecystoduodenostomy, and other anastomoses from the stomach or duodenum into
the intra- or extrahepatic biliary tree. Add the application of these stents through
laparoscopic portals or transgastric or transcolonic neolumens in the setting of
NOTES and one can begin to see the yet unrealized potential of this
technology.
It is with enthusiasm and the humility of knowing, that by the time of this
text’s publication, that there will be continued evolution in SEMS technology
and placement techniques, that the editors proffer Self-Expandable Stents in
the Gastrointestinal Tract.
Seattle, WA, USA Richard A. Kozarek, M.D
Rochester, MN, USA Todd Baron, M.D
Seoul, Republic of Korea Ho-Young Song, M.D
Preface

Acknowledgments
We acknowledge Jane Babione for her invaluable assistance in manuscript
preparation and editing, Anne Marie Howe for clinical practice support, and
our families for their patience and support during the editing of this text.
vii

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Contents
Part 1 History of GI Tract Stenting
1 History of GI Stenting: Rigid Prostheses
in the Esophagus .......................................................................... 3
Shayan Irani and Richard A. Kozarek
2 History of Bile Duct Stenting: Rigid Prostheses ........................ 15
Joseph W. Leung
Part 2 History of SEMS/SEPS Development and Current Design
3 History of Self-Expandable Metal and Self-Expandable
Plastic Stent Development ........................................................... 35
Ho-Young Song, Jin Hyoung Kim, and Chang Jin Yoon
4 Current Designs of Self-Expanding Stents ................................ 51
Hans-Ulrich Laasch
Part 3 Overview of Available Prostheses
5 Esophageal Prostheses ................................................................. 73
Massimo Conio and Antonella De Ceglie
6 Biliary Self-Expandable Metal Stents ........................................ 89
Mohan Ramchandani and D. Nageshwar Reddy
7 Enteric Prostheses ........................................................................ 103
Chan Gyoo Kim and Il Ju Choi
8 Colonic Prostheses........................................................................ 121
Tae Il Kim
Part 4 Indications and Placement Techniques
9 Esophageal Stents: Indications and Placement
Techniques .................................................................................... 129
Andrew S. Ross and Richard A. Kozarek
ix
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