Enteral Wallstent

Fig. 3.2a, b. Enteral Wallstent. a A 10-F delivery system with partly released stent, b Flexibility of released 22-mm stent... 

In five recent series comprising 6-12 patients each (De Baere et aL 1997 Pinto 1997 Soetikno et al. 1998 Binkert et aL 1996 Feretis et al. 1996) various types of Wallstents were used (16-mm vascular rolling membrane, 20 to 22-mm oesophageal, 20 to 22 mm enteral Wallstents). Initial palliative success was achieved in 80%-100% (m=92%) of the total of 43 reported patients with a technical success rate of 83%-100% (m=95%). In all but four patients the stents were inserted via peroral route. Long-term follow-up was limited since most patients died within 6 months. Reobstruction rates varied from 8%-50% (m=25%) but secondary durable palliation until death or at the end of the study was achieved in 80%-100% (m=86%). 

Yim and coworkers (2001) treated their patients with enteral Wallstents of 22 mm diameter and 60 or 90 mm length. The technical success rate was 94%, all by peroral endoscope-assisted route. Clinical improvement was achieved in 86% and long-term palliation was 79% with an 8% reobstruction rate from tumour ingrowth. In both cases the obstruction was successfully treated with a second stent. There were no complications and the mean survival was 17 weeks. 

Razzaq et al. (2001) treated 23 patients. Of these, 21 were treated with enteral Wallstents perorally while the two first patients treated with oesophageal stents had to be approached through a gastrostomy. Technical success was 96% with a clinical long-term... 

Stents used Enteral Wallstent Oesophageal Wallstent Enteral Wallstent (21) Oesophageal Wallstent (2) Enteral Wallstent... 

Fig. 3.10a-c. An 80-year-old patient with carcinoma of the transverse colon, a The obstruction could be passed with the help of the endoscope. Note that the guidewire is placed well beyond the obstruction, b A 22/60-mm enteral Wallstent is being released, c The stent has been released in good position... 

KSW, Kantonsspital Winterthur, m, mean Vascular, oesophageal, biliary. Enteral Wallstent. 

In the two review articles by Mauro et al. (2000) and Zollikofer et al (2001) compiling series with more than ten patients between 1996 and 2000 with a total of 117 and 140 patients, respectively, undergoing preoperative stent placement for acute ileus, a clinical success was achieved in 89%-96%. The technical success rate for crossing the lesion with a guidewire and successive stent placement was 90% and 89%, respectively. The majority were treated with Wallstents (mainly of the oesophageal, vascular or Enteral ... 

Stents used 30-mm Z-stent 18 20 mm oesophageal Wallstent 10-22 mm WS Esopha-Coil Ultrallex Covered, modified Z-stent (2 types) 22-mm oesophageal Wallstent 1+25 mm Memotherm 1 covered GR-Z 20-22 mm oesoph. WS 1+25 mm Memotherm 16 mm vase. WS 20/22 Enteral WS ... 

Fig. 11.9. a Injection of contrast shows a tight stricture at the gastric outlet (arrowheads). The radiopaque tip of the ERCP catheter (arrow) is seen at the distal end of the stricture in the second part of the duodenum (patient prone), b A wire has been passed across the stricture and a through-the-scope delivery system (arrowheads) is advanced over it (Enteral Wallst-ent, Boston Scientific, St. Albans, UK), c After stent release, marked waisting is seen at the level of the stricture. The stent has been placed too distally and the proximal end of the stricture is not covered, d A second Wallstent has been placed overlapping the first one and extending well into the gas-filled antrum (arrowheads). Note the position of the distal end of this (arrow) in the D1/D2 flexure, which may have caused impaction without the first stent... 

Fig. 11.13. a Duodenal obstruction developing after biliary obstruction a 10-Fr straight plastic biliary stent is in situ (arrowheads). Duodenal obstruction has occurred at the D1/D2 flexure (arrow). b After removal a long stricture is evident in the common bile duct (arrowheads), c-e After deployment of a biliary Wallstent (Boston Scientific, St. Albans, UK) a Hanaro enteral stent (Diagmed, Thirsk, UK) is placed... 

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