Clin Endosc.  2016 Mar;49(2):113-123. 10.5946/ce.2016.039.

Development of Biliary and Enteral Stents by the Korean Gastrointestinal Endoscopists

• Shim CS
• Kim JH
• Bok GH

• KMID: 2165034
• DOI: http://doi.org/10.5946/ce.2016.039

Abstract

Stenting in the gastrointestinal tract is a common procedure used for palliation of obstruction in the enteral and biliary tract. Today, stenting of malignant and benign strictures is performed at almost every major tertiary hospital in Korea. Moreover, Korea has become a major global supplier of cutting edge technology in the field of self-expanding metal stents. However, the history of stenting in Korea is relatively short and was far behind that of other nations such as Japan and Germany. The authors are humbled and gratified to have been able to observe the development and application of these stents in Korea, first hand. In this article, the authors review the overall history of stenting with a specific focus on the development of stenting in Korea. The development of esophageal, gastroduodenal, biliary, and colonic stents in Korea are reviewed in this article from a chronological and historical point of view, and a personal account of some of the significant moments of stent development in Korea are described.

Keyword

Biliary stent; Enteral stent; Self expandable metallic stents; Korea

MeSH Terms

Biliary Tract
Colon
Constriction, Pathologic
Gastrointestinal Tract
Germany
Hand
Humans
Japan
Korea
Stents*
Tertiary Care Centers

Figure

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  Fig. 1. Hand-made plastic biliary stent with side holes and side flaps (10 mm in diameter).

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  Fig. 2. Endoscopic esophageal stenting in esophageal cancer with a celestin stent. (A) Celestin stent. (B) Pusher tube (*), stent (**). (C) Esophagogram of mid esophageal cancer. (D) Bougie dilation state. (E) Stent over the endoscope and pusher tube as an introducer clips for marking the length of tumor. (F) Stent just after deployment.

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  Fig. 3. Special esophageal stents for unusual situations. (A) Self-expandable metal stent (SEMS) with antireflux mechanism with long S-shaped flap. (B) SEMS for upper cervical esophageal cancer, a 7 mm short upper end of stent in a flask shape to prevent migration. (C) SEMS with Shim’s technique for antimigration.

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  Fig. 4. Hand-made membrane covered biliary self-expandable metal stent. Membrane-covered self-expandable biliary metal stent in expansion after uncoiling the string modified membrane-covered self-expandable biliary metal stent. Stent material, stainless steel 30 Fr; membrane, polyurethane; introducing apparatus, string pull type.

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  Fig. 5. Covered biliary self-expandable metal stent (SEMS). (A, B) Covered biliary SEMSs and delivery devices. (C-F) Covered biliary SEMSs and expansion from captured position. Implantation of biliary stent into a malignant biliary patient. (G) A X-ray image of fully deployed biliary stent, (H) endoscopic images of fully deployed biliary stent.

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  Fig. 6. (A) Original delivery catheter and coiled stent for esophagal stenting. (B) Deployed EsophaCoil (InStent) in vitro. (C) Modified and extended delivery catheter to 150 cm in length and mounted stent for antroduodenal stenting. Implanting a metallic stent (EsophaCoil stent; InStent) under the fluoroscopic guidance. (D) An image of guide wire inserted deep into duodenum using fluoroscopic image. (E) An image of EsophaCoil stent being inserted following a guide wire. (F) X-ray image after the deployment completed. (G) An endoscopic image of metallic stent placed in gastric outlet region.

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  Fig. 7. First trial of rectal plastic stent in 1988. (A) An esophageal plastic stent (Sumitomo-Bakelite Stent; Sumitomo-Bakelite). (B) X-ray image of an esophageal plastic stent in a malignant obstructive rectal cancer patient (an esophageal stent was placed in reverse).

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  Fig. 8. First trial colonic through-the-scope (TTS) self-expandable metal stent. (A) The partly membrane covered Niti-S stent (Taewoong Medical) with flanges. The proximal part of the flange is not covered with polyurethane. (B) The uncovered Niti-S colon stent, without flanges. (C) The stent-in-stent model (with an outer uncovered stent and an inner partly covered Niti-S stent). (D) Easy stent placement being practiced under an endoscopic view at any obstructed region. Large diameter TTS colonic stent are easily being inserted into a colonoscope channel for easier monitoring of expansion.

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