The Efficacy of Metallic Stent Placement in the Treatment of Colorectal Obstruction

Abstract

ObjectiveTo evaluate the efficacy of newly designed covered and non-covered coated colorectal stents for colonic decompression.Materials and MethodsTwenty-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 26mm, 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.ResultsThirty 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).ConclusionNewly 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.

Usefulness of multifunctional gastrointestinal coil catheter for colorectal stent placement

“…Expandable metallic stents are being increasingly used in palliative nonsurgical therapy or preoperative decompression for malignant colorectal obstructions [1][2][3][4][5][6][7][8]. Before a stent delivery system is passed through a guide wire, close evaluation of stricture length and severity is essential, and successful advancement of the guide wire is mandatory.…”

“…In fluoroscopically colorectal stent placement, passage of a guide wire through a stricture is a major obstacle to the success of the procedure. Although most interventional radiologists use angiographic catheters for passing a guide wire in colorectal stent placement [1][2][3]5], they have some limitations stemming from the tortuous curved angulations of the intestinal tract and intestinal folds [9,10]. In addition, it is not possible to measure stricture length without removal of the guide wire, and it is difficult to opacify the area of the stricture before stent placement.…”

“…Colorectal stent placement is safe and effective for the palliative nonsurgical therapy or preoperative decompression of malignant colorectal obstruction [1][2][3][4][5][6][7][8]. Recently, investigators have improved this increasingly used technique to offer a safer option for the treatment of malignant colorectal obstruction [3][4][5][6][7][8].…”

“…Recently, investigators have improved this increasingly used technique to offer a safer option for the treatment of malignant colorectal obstruction [3][4][5][6][7][8]. In fluoroscopically colorectal stent placement, passage of a guide wire through a stricture is a major obstacle to the success of the procedure.…”

Enteral stent construction: Current principles

“…1,2 There has been a relatively rapid pace of development of new devices, these currently being in their 7th generation. Stents for use in the small and large bowel have slightly differing requirements from esophageal stents.…”