Complications and lessons learned from 10 years of expandable gastrointestinal prostheses

Initially inserted percutaneously for malignant biliary stenoses, expandable gastrointestinal prostheses have evolved as primary treatment for malignant dysphagia and as an alternative to plastic prostheses for some types of obstructive jaundice. They are also in their infancy as a means to palliate unresectable obstructions of the gastric outlet, small bowel, and colorectum. Despite a decade of development, problems persist and include: maldeployment; inadequate expansion; ingrowth; overgrowth; erosion, and migration. This article outlines some of the problems noted and opportunities to improve this still-evolving technology.