Self-expandable metal stents (SEMS) are useful for the non-surgical relief of malignant colonic obstruction. They may be used both as a palliative measure and as a pre-operative bridge to facilitate a one-stage surgical resection of primary colonic tumours. SEMS may be placed endoscopically or by interventional radiologists without the use of endoscopy. In experienced centres SEMS can be successfully placed in approximately 90% of cases. Although it is known that the placement of these devices is feasible, there are no prospective trials comparing stent placement for colonic obstruction to routine surgical care. Additionally, there are no studies comparing the outcome of the method of placement (endoscopic versus radiological). This chapter reviews the types of expandable metal stent used for treatment of colonic obstruction, the indications for their insertion, their methods of insertion, and outcomes following insertion. Future research directions using expandable stents for colonic tumours are also addressed.
"The technical failure rates were 5.8% at the rectosigmoid area, 14.5% at the descending colon, and 15.4% at the transverse and ascending colon. Baron et al. (13, 16) concluded that stents may be safely placed into the right colon using endoscopic techniques and that stent placement under fluoroscopic guidance should be limited to the left colon; whereas, Mainar et al. (1) argued that the endoscopic approach is associated with greater patient discomfort and risks for complications. In our experience, straightening of the redundant colon and stabilization of the stent delivery system were achieved using the guiding sheath. "
[Show abstract][Hide abstract] ABSTRACT: To investigate the technical feasibility, clinical usefulness, and safety of a guiding sheath in fluoroscopic stent placement for patients with malignant colorectal obstructions.
Between June 2007 and January 2011, fluoroscopic placement of a dual colorectal stent was attempted in a total of 97 patients with malignant colorectal obstructions. A polytetrafluoroethylene guiding sheath was used in patients in whom a stent delivery system failed to reach the obstruction. Usefulness of the sheath was evaluated depending on whether the sheath could successfully assist the stent delivery system reach its area of interest.
The guiding sheath was needed in 22 patients (15 men, 7 women; age range, 33-77 years; mean age, 59 years). The overall success rate for passing the sheath to the area of interest was 100%. There were no procedure-related deaths or major complications. The majority of the patients reported mild discomfort. In 2 of 22 patients with successful passing of the sheath to the area of interest, stent placement failed because of failure in the negotiation of a guide wire through the obstruction.
Using a guiding sheath seems to be easy, safe and useful in fluoroscopic stent placement for patients with malignant colorectal obstructions.
Korean journal of radiology: official journal of the Korean Radiological Society 04/2012; 13 Suppl 1(Suppl 1):S83-8. DOI:10.3348/kjr.2012.13.S1.S83 · 1.57 Impact Factor
"Dohmoto  who is the first described using colonic stent for relief of colonic obstruction in 1991. The indication for insertion of colonic stent is palliative treatment in advanced cancer and using as a bridge to surgery . For bridging therapy, there are several advantages in various groups because the need of emergency surgery can be avoided up to ninety percent of cases [22,23]. "
[Show abstract][Hide abstract] ABSTRACT: Traditionally, there are several approaches to manage left-sided colonic carcinoma obstruction, such as tumor resection with primary anastomosis, tumor resection with end-colostomy and loop-colostomy. Recently, colonic stent insertion was introduced as a bridge prior to definite surgery. We demonstrated a hybrid approach for obstructed sigmoid carcinoma using colonic stent, followed by single incision laparoscopic colectomy (SILC). A 58 year-old man presented with complete left-sided colonic obstruction. He underwent emergency colonoscopy with metallic stent placement. One week later, he was performed SILC. He recovered well after the operation without any postoperative complications. The pathological result showed adequacy of oncologic resection. This hybrid approach of colonic stent insertion and SILC can be safely performed.
World Journal of Surgical Oncology 04/2011; 9(1):42. DOI:10.1186/1477-7819-9-42 · 1.41 Impact Factor
"Perforation with free intra-peritoneal gas should be considered as an absolute contraindication. A 2 cm gap between the anal canal and the distal end of the stent is recommended , as a stent placed lower than this is likely to leave the patient with tenesmus, and or incontinence . Lesions in the lower 5–6 cm of the rectum (i.e. "
[Show abstract][Hide abstract] ABSTRACT: For patients with obstructing colonic tumours endoluminal stents provide an alternative to surgical decompression. Used either as permanent palliation, or as a bridge to surgery, colonic stents have been shown to be effective, safe, and cost effective.
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