Ingrowing on me
A 41-year-old woman with a history of Roux-en-Y gastric bypass a decade ago undergoes an endoscopy, given progressive dysphagia. She is found to have a benign gastrojejunostomy stricture, which is treated with a fully covered self-expanding metal stent affixed to the esophageal mucosa with full-thickness sutures. However, a month after placement, dysphagia recurs. Endoscopy reveals significant tissue ingrowth, resulting in upstream flange obstruction. Implementing the stent-in-stent technique (Figure) manages this complication. Which of the following is true regarding the use of stents in the management of GI luminal obstruction?
Partially covered metal stents have the advantage of a decreased migration rate. Partially covered metal stents are shown to have an increased rate of tissue ingrowth compared with fully covered metal stents in a large retrospective multicenter study. Migration rates of stents are proportionally correlated with the severity of stenosis. The efficacy of endoscopic suturing has been firmly established in the prevention of stent migration.
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