Colonic stents: the modern treatment of colonic obstruction

Feo, Leandro; Schaffzin, David M.

doi:10.1007/s12325-010-0094-6

Cited by 33 publications

(27 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, the advantages of colonoscopy are not only limited to the detection and treatment of early cancers. Other therapeutic benefits of colonoscopy include endoscopic hemostasis of bleeding lesions, dilatation of benign strictures and stenting of malignant strictures [20][21][22][23] . Despite these advances in diagnostic and therapeutic colonoscopy, the utility of colonoscopy remains dependent on the cleanliness of the colon or the quality of bowel preparation.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing quality of bowel preparation for colonoscopy

Romero

Mahadeva

2013

WJGE

View full text Add to dashboard Cite

Recent technological advances in colonoscopy have led to improvements in both image enhancement and procedural performance. However, the utility of these technological advancements remain dependent on the quality of bowel preparation during colonoscopy. Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance, such as reduced cecal intubation rates, increased patient discomfort and lower adenoma detection. The most popular bowel preparation regimes currently used are based on either Polyethylene glycol-electrolyte, a non-absorbable solution, or aqueous sodium phosphate, a lowvolume hyperosmotic solution. Statements from various international societies and several reviews have suggested that the efficacy of bowel preparation regimes based on both purgatives are similar, although patients' compliance with these regimes may differ somewhat. Many studies have now shown that factors other than the type of bowel preparation regime used, can influence the quality of bowel preparation among adult patients undergoing colonoscopy. These factors can be broadly categorized as either patient-related or procedure-related. Studies from both Asia and the West have identified patient-related factors such as an increased age, male gender, presence of co-morbidity and socioeconomic status of patients to be associated with poor bowel preparation among adults undergoing routine out-patient colonoscopy. Additionally, procedure-related factors such as adherence to bowel preparation instructions, timing of bowel purgative administration and appointment waiting times for colonoscopy are recognized to influence the quality of colon cleansing. Knowledge of these factors should aid clinicians in modifying bowel preparation regimes accordingly, such that the quality of colonoscopy performance and delivery of service to patients can be optimised.

show abstract

Section: Introductionmentioning

confidence: 99%

Factors influencing quality of bowel preparation for colonoscopy

Romero

Mahadeva

2013

WJGE

View full text Add to dashboard Cite

show abstract

“…Despite the still ongoing scientific debate [39][40][41][42][43] , SEMS for MCRO appears to be the modern treatment for colonic obstruction [39,44,45] . Comparison between colonic SEMS manufactured by major stent companies show no important differences between them [40] .…”

Section: Resultsmentioning

confidence: 99%

Colorectal stenting as first-line treatment in acute colonic obstruction

García-Cano

2013

WJGE

View full text Add to dashboard Cite

Tumoral obstructions in almost the entire gastrointestinal tract can be resolved with interventional digestive endoscopy techniques. Self-expanding metal stent (SEMS) insertion in the obstructed colon is a minimally invasive and relatively simple procedure providing an effective first-line treatment for relief of acute malignant obstruction symptoms and serving either as a preoperative or "bridge to surgery" procedure or as palliative definitive care. This technique was introduced in the early 1990s. Although there is still debate about its real value, a lot of reports have been published since then and the procedure is advocated by many surgical groups as the method of choice for the initial treatment of left-sided tumoral colonic obstruction. Before the procedure, colonic obstruction has to be diagnosed by abdominal radiographs, water contrast enema and/or a computed tomography scan. The greatest information is provided by the latter and it is perhaps the method of choice prior to stenting. Skills and training are mandatory, as in all interventional procedures. The key step for success is to cross the malignant stricture with a guidewire. Care must be taken not to over insufflate an obstructed colon during the procedure. SEMS slide over the guidewire through the endoscope working channel or in parallel, outside the endoscope. An average 7% perforation rate has been reported during the procedure and other minor complications can appear in the follow up. However, as a whole, this technique seems to compare favorably with surgery.

show abstract

“…(1,(12)(13)(14). However, tumor ingrowth and stent migration have been reported as weaknesses in conventional single bare and covered stents, respectively (2-4).…”

Section: Discussionmentioning

confidence: 99%

Clinical effect of double coaxial self-expandable metallic stent in management of malignant colon obstruction

Won

Lee²,

Ku³

et al. 2015

Diagn Interv Radiol

View full text Add to dashboard Cite

ORIGINAL ARTICLE PURPOSEWe aimed to evaluate the clinical effectiveness and safety of double coaxial self-expandable metallic stent (DCSEMS) in management of malignant colonic obstruction as a bridge to surgery or palliation for inoperable patients. METHODSBetween April 2006 and December 2012, 49 patients (27 males and 22 females; median age, 68 years; age range, 38-91 years) were selected to receive decompressive therapy for malignant colonic obstruction by implanting a DCSEMS. Application of DCSEMS was attempted in 49 patients under fluoroscopic guidance. The obstruction was located in the transverse colon (n=2), descending colon (n=7), sigmoid colon (n=24), rectosigmoid junction (n=6), and the rectum (n=10). The intended use of DCSEMS was as a bridge to elective surgery in 23 patients and palliation in 26 patients. RESULTSClinical success, defined as >50% dilatation of the stent with subsequent symptomatic improvement, was achieved in 48 of 49 patients (98%). The stent was properly inserted in all patients. No immediate major procedure-related complications occurred. One patient in the bridge-to-surgery group had colon perforation three days after DCSEMS application. Four patients had late migrations of the double stent. CONCLUSION Application of DCSEMS is safe and effective in management of malignant colonic obstruction; it prevents stent migration and tumor ingrowth and lowers perforation rate during the stent application. F luoroscopic or endoscopic placement of either bare or covered expandable metallic stents was shown to be a safe, easy, and effective technique as a bridge to surgery and palliative treatment of colorectal cancer (1, 2). However, tumor ingrowth and stent migration have been reported as weaknesses in conventional single bare and covered stents, respectively (2-4). The use of bare stents has been hindered by progressive tumor ingrowth through the wire filaments of the bare stents and food residue or hard fecal impaction proximal to or at the level of the stent insertion site (5, 6). In contrast, the use of covered expandable metallic stents has been associated with stent migration (5, 7). To overcome the limitations associated with conventional bare and covered stents, a double coaxial self-expandable metallic stent (DCSEMS) has been developed to combine the strengths of bare and covered stents (7,8).The purpose of the present study was to report our experiences with fluoroscopic-guided placement of double stents in management of malignant colorectal obstruction as a bridge to surgery or palliative treatment. MethodsInformed consent was obtained from each patient and/or the legal guardian after the risks and benefits of the treatment were fully explained. Our Institutional Review Board approved this retrospective study. PatientsBetween April 2006 and December 2012, the images and clinical reports of 49 consecutive patients (27 males and 22 females; median age, 66 years; age range, 38-91 years) with malignant colorectal obstruction, who received decompressed therapy by DCSEMS implantation w...

show abstract

Colonic stents: the modern treatment of colonic obstruction

Cited by 33 publications

References 51 publications

Factors influencing quality of bowel preparation for colonoscopy

Factors influencing quality of bowel preparation for colonoscopy

Colorectal stenting as first-line treatment in acute colonic obstruction

Clinical effect of double coaxial self-expandable metallic stent in management of malignant colon obstruction

Contact Info

Product

Resources

About