SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2021 | VOLUME 19 | ISSUE 2 | 11 REVIEW Oesophageal stenting: where have we come from and where are we going? C Coccia 1 , M Scriba 2 , S Thomson 1 Division of Medical Gastroenterology 1 , Surgical Gastroenterology Clinical Unit 2 , University of Cape Town, and Groote Schuur Hospital Gastrointestinal Unit. 1,2 Introduction Over the past 130 years, stenting the oesophagus has evolved from desperate innovations involving the blind passage of stents into or through an undiagnosed obstructing lesion, to the safe passage of modern self-expanding metal stents (SEMS), which have evolved over the last three decades. During this latter period, better understanding of the pathologies affecting the oesophagus and improved treatment modalities have led to a paradigm shift in stenting. The innovation of SEMS has expanded the role of stenting from purely alleviating dysphagia as a palliative intervention for oesophageal carcinoma, to an array of other uses. Stents are now utilized not only in malignant disease, but for the complications of its treatment, as well as in a variety of benign diseases. This review outlines these temporal changes and the advances that have been made, including their current application in clinical settings. The history of oesophageal stenting The long history of utilizing oesophageal stents for palliating malignant dysphagia originated in 1845 when Leroy d’Etiolles unsuccessfully attempted to tunnel though growths using hollow tubes made of decalcified ivory. 1 Forty years later Sir Charters Symonds recorded the first successful “stenting” using a tube fixed to a funnel made of boxwood, silver or ivory. To prevent migration, he used a silk thread brought out through the mouth or nose and strapped to the ear. 2 Despite many other attempts at creating a functional oesophageal stent, routine use only came into play in 1950’s with the introduction of the Celestin tube. 3 The tube was made of natural polythene and was the first to have a barrel-shaped funnel on the end, which was created to better oppose the oesophageal walls above the stricture. A pilot bougie was passed through the stricture under direct vision using a small oesophagoscope. The bougie’s proximal end fitted snugly in the tapered distal end of the tube and was sutured to prevent separation during delivery. The Correspondence Sandie Thomson email: Sandie.thomson@uct.ac.za distal end of the bougie was then grasped in the stomach via a small gastrostomy, and the bougie and tube were pulled through the stricture to deliver the distal end of the tube in the stomach and the proximal barrel above the stricture. The bougie was then removed through the gastrostomy by cutting off the distal end of the tube which was then anchored by a suture to the stomach as depicted graphically in Figures 1 and 2. Although the first oesophagectomy for cancer was performed by Torek in 1913, 4 it was not until the 1960’s that surgical resection Figure 1. Examples of commonly used rigid stents Figure 2. Delivery techniques for rigid stents