Читать книгу Successful Training in Gastrointestinal Endoscopy - Группа авторов - Страница 101

Placement of endoscopic stents can be considered for palliative treatment of malignant strictures, for refractory benign esophageal strictures, and for management of esophageal perforations and fistulas. Uncoated (also called uncovered) self‐expanding metal stents (SEMS) are associated with extensive hyperplastic tissue ingrowth that can prevent removal and eventually result in obstruction [24]. For this reason, partially covered esophageal SEMS have replaced uncovered esophageal SEMS for the palliation of malignant obstruction. Fully covered SEMS can generally be removed (Figure 5.12) and have therefore been used for perforations or strictures that do not respond to standard dilation. However, as stents carry significant risks of migration and perforation, it is reasonable to attempt at least three standard endoscopic dilations of benign strictures and consider the addition of four‐quadrant steroid injection of the stricture prior to stenting. Most esophageal stents are delivered over a guidewire after first removing the endoscope, typically with fluoroscopy to confirm positioning. A standard or ultrathin endoscope can be advanced alongside the stent delivery catheter to observe the deployment. Some newer stent models with less bulky delivery systems can be placed directly through the endoscope channel (TTS).