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The efficacy of metallic stent placement in the treatment of colorectal obstruction.

Kang SG, Jung GS, Cho SG, Kim JG, Oh JH, Song HY, Kim ES - Korean J Radiol (2002 Apr-Jun)

Bottom Line: Five of six clinical failures involved stent migration and one stent did not expand after successful placement.Complications associated with this procedure were migration (n=6, 20%), pain (n=4, 13.3%), minor bleeding (n=5, 16.7%), incomplete expansion (n=1, 3.3%), and tumor ingrowth (n=1, 3.3%).The migration rate was significantly higher in the type-B group than in other groups (p=0.038).

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Chosun University Medical College, Gwangju, South Korea. gangsg@mail.chosun.ac.kr

ABSTRACT

Objective: To evaluate the efficacy of newly designed covered and non-covered coated colorectal stents for colonic decompression.

Materials and methods: Twenty-six patients, (15 palliative cases and 11 preoperative) underwent treatment for the relief of colorectal obstruction using metallic stents positioned under fluoroscopic guidance. In 24 of the 26, primary colorectal carcinoma was diagnosed, and in the remaining two, recurrent colorectal carcinoma. Twenty-one patients were randomly selected to receive either a type A or type B stent; for the remaining five, type C was used. Type A, an uncovered nitinol wire stent, was lightly coated to ensure structural integrity. Type B (flare type) and C (shoulder type) stents were polyurethane covered and their diameter was 24 and 26 mm, respectively. The rates of technical success, clinical success, and complications were analyzed using the chi-square test, and to analyse the mean period of patency, the Kaplan-Meier method was used.

Results: Thirty of 31 attempted placements in 26 patients were successful, with a technical success rate of 96.8% (30/31) and a clinical success rate of 80.0% (24/30). After clinically successful stent placement, bowel decompression occurred within 1-4 (mean, 1.58+/-0.9) days. Five of six clinical failures involved stent migration and one stent did not expand after successful placement. In the preoperative group, 11 stents, one of which migrated, were placed in ten patients, in all of whom bowel preparation was successful. In the palliative group, 19 stents were placed in 15 patients. The mean period of patency was 96.25+/-105.12 days: 146.25+/-112.93 for type-A, 78.82+/-112.26 for type-B, and 94.25+/-84.21 for type-C. Complications associated with this procedure were migration (n=6, 20%), pain (n=4, 13.3%), minor bleeding (n=5, 16.7%), incomplete expansion (n=1, 3.3%), and tumor ingrowth (n=1, 3.3%). The migration rate was significantly higher in the type-B group than in other groups (p=0.038).

Conclusion: Newly designed covered and non-covered metallic stents of a larger diameter are effective for the treatment of colorectal obstruction. The migration rate of covered stents with flaring is higher than that of other types. For evaluation of the ideal stent configuration for the relief of colorectal obstruction, a clinical study involving a larger patient group is warranted.

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Type-C stent placement inside a type-A stent (patient #21).A. Tumor ingrowth, which developed four months after stent placement, was confirmed by endoscopy.B. Guidewire advanced through previously placed type-A stent.C. Deployment of type-C stent (arrow), which is longer than type A (arrowheads).D. The type-C stent showed good patency and was patent for three months, until the patient's death.
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Figure 4: Type-C stent placement inside a type-A stent (patient #21).A. Tumor ingrowth, which developed four months after stent placement, was confirmed by endoscopy.B. Guidewire advanced through previously placed type-A stent.C. Deployment of type-C stent (arrow), which is longer than type A (arrowheads).D. The type-C stent showed good patency and was patent for three months, until the patient's death.

Mentions: The overall complication rate was 50.0%: 50% for type A, 56.3% for type B, and 33.3% for type C. The complications involved were migration (n=6, 20.0%), pain (n=4, 13.3%), minor bleeding (n=5, 16.7%), incomplete stent expansion (n=1, 3.3%), and tumor ingrowth (n=1, 3.3%) (Table 4). The migration rate was significantly higher in the type-B group (p=0.038), while minor bleeding developed frequently in the type-C group (p=0.037). Two of nine patients with primary rectal cancer and two of 12 with rectosigmoid colon cancer complained of anal pain after stent placement. Two in whom a type-A stent had been placed complained of pain, which in one case was severe; those who underwent type-B stent placement complained of pain in one case, and minor bleeding in two. Type-C stents caused pain in one case and minor bleeding in three, and in one other there was incomplete expansion. Patient #1 underwent emergency colostomy seven months after stent migration. The type-B stent placed in patient #11 migrated nine days after placement, and was replaced with a type-A stent; relief from bowel obstruction lasted 27 days. In patients #21, in whom a type-A stent was inserted, obstruction recurred due to tumor ingrowth and was confirmed by endoscopy. We placed an additional type-C stent inside the type-A stent, and until her death, this patient experienced no further bowel obstruction. (Fig. 4). In patient #23, who underwent type-C stent insertion, another stricture was discovered just below the stent. We removed this, using a hook, replacing it with a type C, which was longer.


The efficacy of metallic stent placement in the treatment of colorectal obstruction.

Kang SG, Jung GS, Cho SG, Kim JG, Oh JH, Song HY, Kim ES - Korean J Radiol (2002 Apr-Jun)

Type-C stent placement inside a type-A stent (patient #21).A. Tumor ingrowth, which developed four months after stent placement, was confirmed by endoscopy.B. Guidewire advanced through previously placed type-A stent.C. Deployment of type-C stent (arrow), which is longer than type A (arrowheads).D. The type-C stent showed good patency and was patent for three months, until the patient's death.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713840&req=5

Figure 4: Type-C stent placement inside a type-A stent (patient #21).A. Tumor ingrowth, which developed four months after stent placement, was confirmed by endoscopy.B. Guidewire advanced through previously placed type-A stent.C. Deployment of type-C stent (arrow), which is longer than type A (arrowheads).D. The type-C stent showed good patency and was patent for three months, until the patient's death.
Mentions: The overall complication rate was 50.0%: 50% for type A, 56.3% for type B, and 33.3% for type C. The complications involved were migration (n=6, 20.0%), pain (n=4, 13.3%), minor bleeding (n=5, 16.7%), incomplete stent expansion (n=1, 3.3%), and tumor ingrowth (n=1, 3.3%) (Table 4). The migration rate was significantly higher in the type-B group (p=0.038), while minor bleeding developed frequently in the type-C group (p=0.037). Two of nine patients with primary rectal cancer and two of 12 with rectosigmoid colon cancer complained of anal pain after stent placement. Two in whom a type-A stent had been placed complained of pain, which in one case was severe; those who underwent type-B stent placement complained of pain in one case, and minor bleeding in two. Type-C stents caused pain in one case and minor bleeding in three, and in one other there was incomplete expansion. Patient #1 underwent emergency colostomy seven months after stent migration. The type-B stent placed in patient #11 migrated nine days after placement, and was replaced with a type-A stent; relief from bowel obstruction lasted 27 days. In patients #21, in whom a type-A stent was inserted, obstruction recurred due to tumor ingrowth and was confirmed by endoscopy. We placed an additional type-C stent inside the type-A stent, and until her death, this patient experienced no further bowel obstruction. (Fig. 4). In patient #23, who underwent type-C stent insertion, another stricture was discovered just below the stent. We removed this, using a hook, replacing it with a type C, which was longer.

Bottom Line: Five of six clinical failures involved stent migration and one stent did not expand after successful placement.Complications associated with this procedure were migration (n=6, 20%), pain (n=4, 13.3%), minor bleeding (n=5, 16.7%), incomplete expansion (n=1, 3.3%), and tumor ingrowth (n=1, 3.3%).The migration rate was significantly higher in the type-B group than in other groups (p=0.038).

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Chosun University Medical College, Gwangju, South Korea. gangsg@mail.chosun.ac.kr

ABSTRACT

Objective: To evaluate the efficacy of newly designed covered and non-covered coated colorectal stents for colonic decompression.

Materials and methods: Twenty-six patients, (15 palliative cases and 11 preoperative) underwent treatment for the relief of colorectal obstruction using metallic stents positioned under fluoroscopic guidance. In 24 of the 26, primary colorectal carcinoma was diagnosed, and in the remaining two, recurrent colorectal carcinoma. Twenty-one patients were randomly selected to receive either a type A or type B stent; for the remaining five, type C was used. Type A, an uncovered nitinol wire stent, was lightly coated to ensure structural integrity. Type B (flare type) and C (shoulder type) stents were polyurethane covered and their diameter was 24 and 26 mm, respectively. The rates of technical success, clinical success, and complications were analyzed using the chi-square test, and to analyse the mean period of patency, the Kaplan-Meier method was used.

Results: Thirty of 31 attempted placements in 26 patients were successful, with a technical success rate of 96.8% (30/31) and a clinical success rate of 80.0% (24/30). After clinically successful stent placement, bowel decompression occurred within 1-4 (mean, 1.58+/-0.9) days. Five of six clinical failures involved stent migration and one stent did not expand after successful placement. In the preoperative group, 11 stents, one of which migrated, were placed in ten patients, in all of whom bowel preparation was successful. In the palliative group, 19 stents were placed in 15 patients. The mean period of patency was 96.25+/-105.12 days: 146.25+/-112.93 for type-A, 78.82+/-112.26 for type-B, and 94.25+/-84.21 for type-C. Complications associated with this procedure were migration (n=6, 20%), pain (n=4, 13.3%), minor bleeding (n=5, 16.7%), incomplete expansion (n=1, 3.3%), and tumor ingrowth (n=1, 3.3%). The migration rate was significantly higher in the type-B group than in other groups (p=0.038).

Conclusion: Newly designed covered and non-covered metallic stents of a larger diameter are effective for the treatment of colorectal obstruction. The migration rate of covered stents with flaring is higher than that of other types. For evaluation of the ideal stent configuration for the relief of colorectal obstruction, a clinical study involving a larger patient group is warranted.

Show MeSH
Related in: MedlinePlus