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Dual-Design Expandable Colorectal Stent for a Malignant Colorectal Obstruction: Preliminary Prospective Study Using New 20-mm Diameter Stents

  • Chou, Sandas Qi Hua (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Ho-Young (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jin-Hyoung (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Jung-Hoon (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Fan, Yong (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Heui-Ran (Department of Microbiology, Bio-Medical Institute Technology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoon, Yong-Sik (Department of Colorectal Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jin-Cheon (Department of Colorectal Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Published : 2012.02.01

Abstract

Objective: To evaluate the safety and effectiveness of a 20-mm diameter dual-design expandable colorectal stent for malignant colorectal obstruction. Materials and Methods: The study series included 34 patients with malignant colorectal obstruction who underwent implantation of a 20-mm dual-design expandable colorectal stent in our department between March 2009 and June 2010. The 20-mm dual-design expandable colorectal stent was placed by using a 3.8-mm delivery system that had 28-mm diameter proximal and distal ends. Among the 34 patients, stent placement for palliation was performed in 20 patients, while stent placement for bridge to surgery was performed in 14 patients. Results: A 97% (33 of 34) success rate was achieved for the stent placement. The perforation rate in the bridge to surgery group was 7% (1 of 14), compared to 0% (0 of 19) in palliative group. Migration occurred in one of 33 patients (3%) at 30 days after stent placement. Conclusion: The placement of a 20-mm diameter dual-design stent appears to be clinically safe and effective for the management of colorectal obstruction, with low perforation and migration rates.

Keywords

References

  1. Song HY, Kim JH, Shin JH, Kim HC, Yu CS, Kim JC, et al. A dual-design expandable colorectal stent for malignant colorectal obstruction: results of a multicenter study. Endoscopy 2007;39:448-454 https://doi.org/10.1055/s-2007-966270
  2. Repici A, De Caro G, Luigiano C, Fabbri C, Pagano N, Preatoni P, et al. WallFlex colonic stent placement for management of malignant colonic obstruction: a prospective study at two centers. Gastrointest Endosc 2008;67:77-84 https://doi.org/10.1016/j.gie.2007.08.019
  3. Shin SJ, Kim TI, Kim BC, Lee YC, Song SY, Kim WH. Clinical application of self-expandable metallic stent for treatment of colorectal obstruction caused by extrinsic invasive tumors. Dis Colon Rectum 2008;51:578-583 https://doi.org/10.1007/s10350-008-9207-6
  4. Repici A, Fregonese D, Costamagna G, Dumas R, Kahler G, Meisner S, et al. Ultraflex precision colonic stent placement for palliation of malignant colonic obstruction: a prospective multicenter study. Gastrointest Endosc 2007;66:920-927 https://doi.org/10.1016/j.gie.2007.03.1042
  5. Fregonese D, Naspetti R, Ferrer S, Gallego J, Costamagna G, Dumas R, et al. Ultraflex precision colonic stent placement as a bridge to surgery in patients with malignant colon obstruction. Gastrointest Endosc 2008;67:68-73 https://doi.org/10.1016/j.gie.2007.05.022
  6. Fischer A, Schrag HJ, Goos M, Obermaier R, Hopt UT, Baier PK. Transanal endoscopic tube decompression of acute colonic obstruction: experience with 51 cases. Surg Endosc 2008;22:683-688 https://doi.org/10.1007/s00464-007-9461-z
  7. Baron TH. Colonic stenting: technique, technology, and outcomes for malignant and benign disease. Gastrointest Endosc Clin N Am 2005;15:757-771 https://doi.org/10.1016/j.giec.2005.08.005
  8. Repici A, Pagano N, Hervoso CM, Danese S, Nicita R, Preatoni P, et al. Metal stents for malignant colorectal obstruction. Minim Invasive Ther Allied Technol 2006;15:331-338 https://doi.org/10.1080/13645700601037954
  9. Breitenstein S, Rickenbacher A, Berdajs D, Puhan M, Clavien PA, Demartines N. Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction. Br J Surg 2007;94:1451-1460 https://doi.org/10.1002/bjs.6007
  10. Dionigi G, Villa F, Rovera F, Boni L, Carrafiello G, Annoni M, et al. Colonic stenting for malignant disease: review of literature. Surg Oncol 2007;16 Suppl 1:S153-155 https://doi.org/10.1016/j.suronc.2007.10.017
  11. Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 2004;99:2051-2057 https://doi.org/10.1111/j.1572-0241.2004.40017.x
  12. Khot UP, Lang AW, Murali K, Parker MC. Systematic review of the efficacy and safety of colorectal stents. Br J Surg 2002;89:1096-1102 https://doi.org/10.1046/j.1365-2168.2002.02148.x
  13. Camunez F, Echenagusia A, Simo G, Turegano F, Vazquez J, Barreiro-Meiro I. Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation. Radiology 2000;216:492-497 https://doi.org/10.1148/radiology.216.2.r00au12492
  14. Choo IW, Do YS, Suh SW, Chun HK, Choo SW, Park HS, et al. Malignant colorectal obstruction: treatment with a flexible covered stent. Radiology 1998;206:415-421 https://doi.org/10.1148/radiology.206.2.9457194
  15. Jung GS, Song HY, Kang SG, Huh JD, Park SJ, Koo JY, et al. Malignant gastroduodenal obstructions: treatment by means of a covered expandable metallic stent-initial experience. Radiology 2000;216:758-763 https://doi.org/10.1148/radiology.216.3.r00au05758
  16. Grunshaw ND, Ball CS. Palliative treatment of an enterorectal fistula with a covered metallic stent. Cardiovasc Intervent Radiol 2001;24:438-440 https://doi.org/10.1007/s00270-001-0056-0
  17. Law WL, Choi HK, Chu KW. Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg 2003;90:1429-1433 https://doi.org/10.1002/bjs.4311
  18. Kang SG, Jung GS, Cho SG, Kim JG, Oh JH, Song HY, et al. The efficacy of metallic stent placement in the treatment of colorectal obstruction. Korean J Radiol 2002;3:79-86 https://doi.org/10.3348/kjr.2002.3.2.79
  19. Kim JH, Song HY, Li YD, Shin JH, Park JH, Yu CS, et al. Dual-design expandable colorectal stent for malignant colorectal obstruction: comparison of flared ends and bent ends. AJR Am J Roentgenol 2009;193:248-254 https://doi.org/10.2214/AJR.08.2003
  20. Mainar A, De Gregorio Ariza MA, Tejero E, Tobio R, Alfonso E, Pinto I, et al. Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery--results of a multicenter study. Radiology 1999;210:65-69 https://doi.org/10.1148/radiology.210.1.r99ja0665
  21. Liberman H, Adams DR, Blatchford GJ, Ternent CA, Christensen MA, Thorson AG. Clinical use of the self-expanding metallic stent in the management of colorectal cancer. Am J Surg 2000;180:407-411; discussion 412 https://doi.org/10.1016/S0002-9610(00)00492-X
  22. Meisner S, Hensler M, Knop FK, West F, Wille-Jorgensen P. Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center. Dis Colon Rectum 2004;47:444-450 https://doi.org/10.1007/s10350-003-0081-y
  23. de Gregorio MA, Mainar A, Tejero E, Tobio R, Alfonso E, Pinto I, et al. Acute colorectal obstruction: stent placement for palliative treatment--results of a multicenter study. Radiology 1998;209:117-120 https://doi.org/10.1148/radiology.209.1.9769821
  24. Xinopoulos D, Dimitroulopoulos D, Theodosopoulos T, Tsamakidis K, Bitsakou G, Plataniotis G, et al. Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis. Surg Endosc 2004;18:421-426 https://doi.org/10.1007/s00464-003-8109-x
  25. Scurtu R, Barrier A, Andre T, Houry S, Huguier M. [Self-expandable metallic stent for palliative treatment of colorectal malignant obstructions: risk of perforation]. Ann Chir 2003;128:359-363 https://doi.org/10.1016/S0003-3944(03)00118-4
  26. van Hooft JE, Fockens P, Marinelli AW, Timmer R, van Berkel AM, Bossuyt PM, et al. Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy 2008;40:184-191 https://doi.org/10.1055/s-2007-995426
  27. Small AJ, Baron TH. Comparison of Wallstent and Ultraflex stents for palliation of malignant left-sided colon obstruction: a retrospective, case-matched analysis. Gastrointest Endosc 2008;67:478-488 https://doi.org/10.1016/j.gie.2007.08.043
  28. Kim JH, Song HY, Hu HT, Kang YK, Jung HY, Yook JH, et al. Palliative treatment of malignant gastric outlet obstructions with a large-diameter metallic stent: prospective preliminary study. J Vasc Interv Radiol 2010;21:1125-1128 https://doi.org/10.1016/j.jvir.2010.03.010

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