Self-expanding metal stents for treatment of anastomotic complications after colorectal resection

Lamazza, Antonietta; Fiori, Enrico; Masi, E. De; Scoglio, Daniele; Sterpetti, Antonio V.; Lezoche, Emanuele

doi:10.1055/s-0032-1326488

Cited by 28 publications

(19 citation statements)

References 9 publications

(8 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Briefly, we adopted a modification of previously described technique, a pediatric nasogastroscope (4.8 mm in diameter) was used to pass the obstruction (30,31). Under direct vision, the guidewire was passed through the nasogostrocope above the obstructed bowel segment (32). Fluoroscopy was also used to follow the course of the guidewire and the deployment of the stent.…”

Section: Methodsmentioning

confidence: 99%

Resection or Stenting in the Treatment of Symptomatic Advanced Metastatic Rectal Cancer: A Dilemma

et al. 2019

View full text Add to dashboard Cite

Background/Aim: Patients affected with Stage IV colorectal cancer and unresectable metastases represent a heterogeneous group. Resection of the primary tumor or stent positioning followed by chemotherapy and/or targeted therapies still represent a difficult choice for surgeons. Patients and Methods: From February 2013 to September 2019, 46 patients were enrolled into a prospective randomized open label parallel trial presenting with Stage IVA and IVB rectal cancer, unresectable metastases and symptoms of subacute large bowel obstruction. Our population was divided into two groups: Group 1 included 20 patients who underwent placement of a self-expandable metal stent and Group 2 included 26 patients in whom primary tumor resection was performed. Results: Oneyear actuarial survival rate of Group 1 was significantly lower compared to Group 2. Overall 17 patients had survival longer than 1-year (3 in Group 1 and 14 in Group 2). Cox regression analysis showed that endoscopic stent positioning and the suspension of the chemotherapy because of deterioration of liver function tests were the two most important factors negatively influencing survival. Conclusion: Patients affected with stage IVA and IVB rectal cancer and symptoms of bowel obstruction had a significant longer survival rate when submitted to surgical rectal resection followed by chemotherapy. Colorectal cancer is a commonly diagnosed cancer. More than 25% of the patients have an initial diagnosis at a Stage IV, with a 5-year overall survival ranging from 10 to 18% (1).

show abstract

Section: Methodsmentioning

confidence: 99%

Resection or Stenting in the Treatment of Symptomatic Advanced Metastatic Rectal Cancer: A Dilemma

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Some experiences with benign (mostly diverticular and radiation-induced) strictures achieved a high rate of technical success (90%) but limited clinical success (56–87%), due to either acute inflammation or mural stiffness. Additionally, the complication rates (perforation 12–20%, migration 40%, recurrent obstruction 14%) are significantly higher than those observed in the treatment of obstructing CRC [24–26]. Conversely, the use of biodegradable stents or removable covered SEMS is being investigated in patients with anastomotic strictures [6, 7].…”

Section: Stent Management Of Benign Colonic Disordersmentioning

confidence: 99%

Endoscopic stenting of malignant, benign and iatrogenic colorectal disorders: a primer for radiologists

2019

View full text Add to dashboard Cite

In recent years, endoscopic placement of intraluminal stents is increasingly used to manage a widening range of colorectal disorders. Self-expanding metal stents represent an established alternative to surgery for the palliation of unresectable carcinomas and currently allow a “bridge-to-surgery” strategy to relieve large bowel obstruction and optimise the patients’ clinical conditions before elective oncologic resection. Additionally, intraluminal stents represent an appealing option to manage obstructing extracolonic tumours and selected patients with benign conditions such as refractory anastomotic strictures and post-surgical leaks. This educational paper reviews the technical features and current indications of colorectal stenting and presents the expected and abnormal radiographic, CT and MRI appearances observed during the endoscopic management of malignant, benign and iatrogenic colonic disorders with stents. The aim is to provide radiologists with a thorough familiarity with stent-related issues, which is crucial for appropriate reconstruction of focused CT images, correct interpretation of early post-procedural studies and elucidation of stent-related complications such as misplacement, haemorrhage, perforation, migration and re-obstruction.

show abstract

“…A partially covered self-expandable metallic stent (PCSEMS) is of proven benefit in patients with inoperable malignant gastric outlet obstruction or in those who are unsuitable for surgery owing to the presence of significant comorbid obstruction [13][14][15], and the use of a PCSEMS for management of benign gastrointestinal (GI) disorders, including esophageal variceal bleeding, benign upper GI tract leaks, or perforation, is increasing [16][17][18][19]; its use has also been attempted for management of several benign gastrointestinal strictures, including Crohn's disease strictures, benign esophageal obstruction, anastomotic complications after bariatric surgery, or anastomotic complications after colorectal resection [20][21][22][23][24]. However, its use for palliation in patients with benign anastomotic stricture after LAG is not well established.…”

Section: Introductionmentioning

confidence: 99%

Partially covered self-expandable metallic stent for postoperative benign strictures associated with laparoscopy-assisted gastrectomy

et al. 2014

View full text Add to dashboard Cite

Background A partially covered self-expandable metallic stent (PCSEMS) is of proven benefit in palliation of unresectable or inoperable malignant gastric outlet obstruction. However, its use in patients with benign anastomotic stricture after laparoscopy-assisted gastrectomy (LAG) is not well established. Methods Patients who between May 2007 and June 2012 underwent PCSEMS placement for management of benign gastrointestinal obstruction after LAG were included in this retrospective analysis. The primary outcomes were the technical success and clinical success of the PCSEMS. The secondary outcomes were procedure-related complications and PCSEMS dysfunction. Results Eleven patients (six women, five men, mean age 53.5 years, range 15-76 years) underwent successful placement of a PCSEMS for management of benign anastomotic strictures after LAG and were followed-up for a mean of 20.6 months (range 7.9-55.6 months). The mean gastric outlet obstruction scoring system (GOOSS) score was 0.36 before PCSEMS placement and 1.55 (p = 0.010) 24-48 h after PCSEMS placement. All of the patients were able to tolerate a solid diet (GOOSS score 3) after 1 week. There were no major or minor procedure-related complications. Stent dysfunction occurred in four patients (three distal migrations, one proximal migration), and stent removal was successful in all of the remaining patients after a mean of 2.0 months (1.1-3.0 months). Obstructive symptoms recurred in two patients (one after proximal migration, one after stent removal) and were treated successfully with PCSEMS reinsertion and balloon dilation. Conclusions A PCSEMS may be a feasible and effective option for management of benign anastomotic strictures after LAG which could avoid secondary surgery.

show abstract

Self-expanding metal stents for treatment of anastomotic complications after colorectal resection

Cited by 28 publications

References 9 publications

Resection or Stenting in the Treatment of Symptomatic Advanced Metastatic Rectal Cancer: A Dilemma

Resection or Stenting in the Treatment of Symptomatic Advanced Metastatic Rectal Cancer: A Dilemma

Endoscopic stenting of malignant, benign and iatrogenic colorectal disorders: a primer for radiologists

Partially covered self-expandable metallic stent for postoperative benign strictures associated with laparoscopy-assisted gastrectomy

Contact Info

Product

Resources

About