Abstract and Introduction
Abstract
Purpose of review: Gastrointestinal stents offer a feasible, safe, cost effective, and minimally invasive method for reestablishing luminal patency. Previous clinical reports and systematic reviews have demonstrated the role of enteral stents in both the upper and lower gastrointestinal tract. Over the last two decades, the rapid development of deep enteroscopy in concert with the evolution of various stent devices/deployment mechanisms has enabled placement of enteral stents in the mid-gut; hence this has been increasingly reported. The present article focuses on stenting in the mid-gut, a relatively novel term, referring to the small bowel between the ampulla and the ileocecal valve.
Recent findings: Mid-gut stenting is technically more difficult than stenting in the upper and lower gastrointestinal tract, and therefore requires particular expertise, restricting its widespread utility. In total, 86 reported cases involving mid-gut stent deployment, by either endoscopic approaches (80.2%) or percutaneous approaches (19.8%), have been published. Although limited, these results have demonstrated that mid-gut stenting is reliable, effective, and a minimally invasive method for palliating malignant obstruction, as well as sealing leaks and fistulae.
Summary: This article reviews the current status of mid-gut stenting, including endoscopic technique. The article also speculates about the potential for future advances within this field.
Introduction
Gastrointestinal stents have represented an exciting development in the field of gastroenterology in recent decades. Their use offers a feasible, safe, cost effective, and minimally invasive method for reestablishing luminal patency in a variety of scenarios. They may be utilized for palliation or as a bridge for operative management of luminal obstruction, leaks, or fistulae. Multiple clinical reports and systematic reviews have demonstrated their role in both the upper and lower gastrointestinal tract. With the evolution of deep enteroscopy techniques and percutaneous interventional procedures, there has been growing interest in interventional procedures in the deep small bowel, including placement of enteral stents in the middle gastrointestinal tract. This new term, middle gastrointestinal, also referred to as mid-gastrointestinal tract or mid-gut, refers to the small bowel extending from the ampulla of Vater to the ileocecal valve. Since the term mid-gut was coined in 2006, more than 50 publications involving the term have been reported from over 10 countries of Europe, North America, South America, and Asia. There exists, however, no systematic review of these reports. This article reviews the use of stents in the mid-gut and discusses endoscopic techniques for deployment of stents in the mid-gut, and speculates on the future advances in this field. A Medline search of English language publications was performed prior to January 2012 related to mid-gut stenting by using the following search terms and their adjective derivatives: colonoscopy, enteral stent, enteroscopy, duodenum, gastroscopy, ileum, mid-gut, jejunum, and percutaneous. Studies published only as abstracts were excluded.