Self-expandable stents in malignant colonic obstruction: insertion assisted with a sphincterotome in technically difficult cases

Vázquez-Iglesias, J. L.; González-Conde, Benito; Vázquez-Millán, Maria Angeles; Estévez-Prieto, Emilio; Alonso-Aguirre, Pedro

doi:10.1016/j.gie.2005.04.028

Cited by 11 publications

(8 citation statements)

References 8 publications

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“…Our overall technical success rate of 92.1% and clinical success rate of 87.2% are consistent with previous reports [6,12,13]. In the literature, the technical failure rate of approximately 8% is mainly due to inability to make the guidewire progress across the obstruction, even with the use of a sphincterotome [14], and the clinical failure rate is about 5%. Diffuse peritoneal carcinomatosis was responsible for poor stent function in our series and therefore does not appear to be a good indication for stenting.…”

Section: Discussionsupporting

confidence: 90%

“…Nos pourcentages globaux de succès technique de 92,1 et clinique de 87,2, sont comparables à des séries anté-rieures [6,12,13]. Dans la littérature, le taux d'échec d'insertion d'une endoprothèse est d'environ 8 %, en raison essentiellement de l'impossibilité de franchir l'obstacle par le fil guide, même avec l'utilisation d'un sphinctérotome [14], et le taux d'échec clinique d'environ 5 %. Une carcinose péritonéale diffuse était responsable d'un mauvais fonctionnement des prothèses dans notre série et ne nous semble pas une bonne indication pour des endoprothèses.…”

Section: Discussionunclassified

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Douze années de pose d’endoprothèses rectocoliques: résultats et suivi chez 204 patients

et al. 2008

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Objectifs : Les buts de cette étude étaient d'évaluer la faisabilité et l'efficacité à long terme de la mise en place d'endoprothèses métalliques ou plastiques pour des sté-noses recto-coliques malignes ou bénignes dans la « vraie vie ».Patients et méthodes : De septembre 1994 à septembre 2006, 204 patients consécutifs (118 femmes, 86 hommes, âge moyen : 73,2 ans, extrêmes : 49-97 ans) présentant une obstruction rectocolique partielle ou complète, étaient traités par une ou plusieurs endoprothèses métalliques ou plastiques. Une pose d'endoprothèse était tentée pour 168 patients porteurs d'une sténose colique maligne en situation palliative, pour 17 malades porteurs également d'un cancer avant un geste chirurgical curatif, pour 19 patients présentant une sténose bénigne, mais contreindiqués pour la chirurgie en raison d'un état général trop altéré. La pose des prothèses était réalisée par voie endoscopique et radioscopique. Différents modèles de prothèses étaient utilisés, incluant les Enteral Wallstent, Wallflex, Colonic Z stent, Ultraflex precision, Choo Stent, Hanarostent et Polyflex. Les données sur l'efficacité de la procédure, les complications et le devenir des patients étaient collectées rétrospectivement à partir des médecins traitants qui ont suivi leurs patients jusqu'à leur décès.Résultats : La pose d'une endoprothèse était effectuée avec succès chez 154 patients en situation palliative (91,6 %), chez les 17 patients avant la chirurgie curative (100 %) et chez 15 malades porteurs d'une sténose bénigne (78 %). Une complication survenait pour 28 patients : perforation colique (n = 8) ; inefficacité (n = 8) ; ré-obstruction par matières fécales ou progression tumorale (n = 6) ; migration (n = 4) ; douleur abdominale sévère (n = 1). Une patiente décédait. Une deuxième endoprothèse était rendue nécessaire ultérieurement chez 6 malades.Conclusions : La pose d'une prothèse rectocolique par voie endoscopique est un traitement palliatif efficace en cas d'obstruction maligne. Ce traitement est également efficace avant un geste chirurgical curatif et pour certaines sténoses bénignes en l'absence d'alternatives thérapeu-tiques moins agressives. Mots clés : Endoprothèse -Sténose colorectale -Traitement endoscopique Twelve years of colorectal stenting: results and follow-up in 204 patientsAbstract: Background and study aims: This study was designed to evaluate the feasibility, effectiveness, and outcome of endoscopic, self-expanding metallic or plastic stents for relief of benign or malignant obstruction of the colon and rectum, in the "real world".Patients and methods: From September 1994 to September 2006, 204 consecutive patients (118 females, 86 males, mean age 73.2 years, range 49 -97) with partial or complete colorectal obstruction were managed with one or several endoscopic self-expanding metallic stents. Stent insertion was attempted for palliation in 168 nonsurgical patients with malignant colonic obstruction, as a "bridge to surgery" in 17 patients with an obstructing colorectal malignancy, and for benig...

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Section: Discussionsupporting

confidence: 90%

Section: Discussionunclassified

Douze années de pose d’endoprothèses rectocoliques: résultats et suivi chez 204 patients

et al. 2008

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“…In our practice, determinations are made by reviewing images of CT scans. According to the images of the CT scans, we found the mean length of strictures was not beyond 8 cm and cannulation through a stricture with a hydrophilic biliary guidewire was feasible [11]. In difficult cases, such as complete obstructions, a biliary sphincterotome-aided cannulation can facilitate a successful passage of a guidewire through a stricture [11,12].…”

Section: Discussionmentioning

confidence: 97%

Endoscopic Self-Expandable Metallic Stent Insertion without Fluoroscopic Guidance Is Feasible and Safe for Acute Colonic Obstruction Caused by Colorectal Cancer

Feng

et al. 2020

Gastroenterology Research and Practice

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Aims. Endoscopic self-expandable metallic stent (SEMS) insertion for acute colonic obstruction caused by colorectal cancer (CRC) is always performed under fluoroscopic guidance. This study evaluated the feasibility and safety of an endoscopic stenting procedure without fluoroscopic guidance. Methods. A total of 36 patients with an acute colonic obstruction caused by CRC underwent endoscopic SEMS insertion using a colonoscope without fluoroscopic guidance, followed by analyses of the technical and clinical success and short-term complications. Results. Total technical success rate and clinical success rate were 91.7% and 86.1%, respectively. The mean procedure time was 21.2±10.3 minutes. There was no stent dislodgement. One case of hematochezia and two cases of tenesmus occurred in patients with left-sided complete obstructions. No other short-term complications occurred. Procedure time, technical success, and clinical success rate were 16.3±9.4 minutes, 93.1%, and 89.6% for left-sided obstructions, respectively, and were 26.8±10.7 minutes, 85.7%, and 71.4% for right-sided obstructions, respectively. For complete obstructions, procedure time, technical success, and clinical success rate were 22.5±8.9 minutes, 90%, and 83.3%, respectively. In the incomplete cases, procedure time, technical success, and clinical success were 13.5±6.7 minutes, 100%, and 100%, respectively. Technical success, clinical success, and short-term complications were not differed between lesion locations and degrees. Conclusions. This simple technique is feasible and safe for palliation of acute colonic obstruction caused by CRC.

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“…Efforts for proper placement of the guide wire with side-viewing endoscope and sphincterotome-assisted techniques have been reported 6,7. However, these techniques were performed only in large bowel obstruction and were not tried in upper gastrointestinal obstruction.…”

Section: Discussionmentioning

confidence: 99%

Ultrathin Endoscope-Assisted Method for the Management of Upper Gastrointestinal Obstruction to Avoid Technical Failure

Kim

Song

et al. 2013

Clin Endosc

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Background/AimsEndoscopic management of upper gastrointestinal obstruction is safe and feasible. However, its technical and clinical success rate is about 90%, which is primarily due to inability to pass a guide-wire through the stricture. The aim of this study was to evaluate the usefulness of an ultrathin endoscope for correct placement of guide wire to avoid technical failure in upper gastrointestinal obstruction.MethodsRetrospective assessment of ultrathin endoscope to traverse the stenosis of the upper gastrointestinal tract in technically difficult cases was performed. Technical and clinical success rates and immediate complications were analyzed.ResultsNine cases were included in this study (eight cases of stent insertion and one case of balloon dilatation). Technical success was achieved in all of the patients (100%) and oral feeding was feasible in all of the cases (100%). Immediate complications, such as migration, perforation, and hemorrhage, did not develop in any of the cases.ConclusionsUltrathin endoscope-assisted method for upper gastrointestinal obstruction is potentially safe and useful to avoid technical failure.

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Self-expandable stents in malignant colonic obstruction: insertion assisted with a sphincterotome in technically difficult cases

Cited by 11 publications

References 8 publications

Douze années de pose d’endoprothèses rectocoliques: résultats et suivi chez 204 patients

Douze années de pose d’endoprothèses rectocoliques: résultats et suivi chez 204 patients

Endoscopic Self-Expandable Metallic Stent Insertion without Fluoroscopic Guidance Is Feasible and Safe for Acute Colonic Obstruction Caused by Colorectal Cancer

Ultrathin Endoscope-Assisted Method for the Management of Upper Gastrointestinal Obstruction to Avoid Technical Failure

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