The Feasibility of 18-mm-Diameter Colonic Stents for Obstructive Colorectal Cancers

Ogawa, Satoshi; Ishii, Tatsuya; Minaga, Kosuke; Nakatani, Yasuki; Hatamaru, Keiichi; Akamatsu, Takuji; Seta, Takeshi; Urai, Shunji; Uenoyama, Yoshito; Yamashita, Yoshihisa; Kudo, Masatoshi

doi:10.1159/000481229

Cited by 8 publications

(3 citation statements)

References 23 publications

(31 reference statements)

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“…Comparisons of SEMSs with several diameters did not show any differences in technical success, clinical success, or adverse events including perforation [22, 76 -79]. Smallercaliber stents were considered to produce less mechanical stress, with a potentially decreased perforation rate [76,79]. However, a few studies have suggested an association between small-diameter stents (< 24 mm) and adverse events, in particular stent migration [21, 80 -82].…”

Section: Recommendationmentioning

confidence: 99%

Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020

et al. 2020

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Main RecommendationsThe following recommendations should only be applied after a thorough diagnostic evaluation including a contrast-enhanced computed tomography (CT) scan. 1 ESGE recommends colonic stenting to be reserved for patients with clinical symptoms and radiological signs of malignant large-bowel obstruction, without signs of perforation. ESGE does not recommend prophylactic stent placement.Strong recommendation, low quality evidence. 2 ESGE recommends stenting as a bridge to surgery to be discussed, within a shared decision-making process, as a treatment option in patients with potentially curable left-sided obstructing colon cancer as an alternative to emergency resection.Strong recommendation, high quality evidence. 3 ESGE recommends colonic stenting as the preferred treatment for palliation of malignant colonic obstruction.Strong recommendation, high quality evidence. 4 ESGE suggests consideration of colonic stenting for malignant obstruction of the proximal colon either as a bridge to surgery or in a palliative setting.Weak recommendation, low quality evidence. 5 ESGE suggests a time interval of approximately 2 weeks until resection when colonic stenting is performed as a bridge to elective surgery in patients with curable left-sided colon cancer.Weak recommendation, low quality evidence. 6 ESGE recommends that colonic stenting should be performed or directly supervised by an operator who can demonstrate competence in both colonoscopy and fluoroscopic techniques and who performs colonic stenting on a regular basis.Strong recommendation, low quality evidence. 7 ESGE suggests that a decompressing stoma as a bridge to elective surgery is a valid option if the patient is not a candidate for colonic stenting or when stenting expertise is not available.Weak recommendation, low quality evidence.

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Section: Recommendationmentioning

confidence: 99%

Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020

et al. 2020

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“…These devices are capable of holding tissue around the endoscope but not the tissue away from it. Large size stents were clinically tested for the treatment of obstructive colorectal cancers [7]. However, the mesh of stents is normally fine and performing surgical tasks in between the mesh is not realistic.…”

Section: Introductionmentioning

confidence: 99%

Pneumatically Actuated Deployable Tissue Distension Device for NOTES for Colon

Miyasaka

Liu

Cao

et al. 2019

2019 International Conference on Robotics and Automation (ICRA)

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When performing some surgical tasks inside colon with NOTES technology, colon tissue could block the task space and occlude the endoscopic vision. In order to solve this problem, we developed a pneumatically driven deployable and undeployable structure which can distend collapsing tissue and can be delivered through a 4.5 mm endoscopic channel. The structure is designed to be flexible enough to pass through colon's tortuous pathway. Also, it is designed to hold its shape without continually applying air pressure after deployment. This allows to make use of an endoscopic channel for the other surgical instruments. Besides, due to the compliant nature of the device, it is safe to deploy inside a smaller space than its maximum deployable size. The functionality of the device was verified with an in-vitro experiment. The structure was successfully deployed inside a pig's colon with an inner diameter of 60 mm by applying 3.5 bars of air pressure and created a sufficient task space for surgical operations.

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“…Small diameter stents mitigate the mechanical impact of the stents on the tumor and the colonic wall, and can reduce the perforation rate. Ogawa et al [7] found that the 18-mm diameter stents were effective similar to 22-mm diameter stents. Because 18-mm diameter stents are easy to handle and produce less mechanical stress, they have the potential to decrease the perforation rate and mitigate the stent's impact on the tumors.…”

mentioning

confidence: 96%