Usefulness of multifunctional gastrointestinal coil catheter for colorectal stent placement

The clinical outcomes of the radiologic method for self-expandable metal-stent placement in patients with colorectal obstruction: A prospective study

OBJECTIVES

To assess the clinical outcomes of self-expandable metal stent (SEMS) placement for patients with colorectal obstruction.

METHODS

A total of 61 patients underwent SEMS placement using computerized tomography (CT) to confirm malignancy of intrinsic origin and evaluate the exact location, notch, and extent of the disruptive laceration.

RESULTS

The overall technical success rate and clinical success rate of SEMS placement using the radiological method were 59 (96.7%) and 57 (93.4%), respectively. The technical success rate and clinical success rate of SEMS placement in the palliative and bridge to elective surgery (BTS) groups were 35 (97.2%), 24 (96.0%), 33 (91.7%), and 24 (96.0%). The median cumulative primary stent patency duration and patients' survival of SEMS placement was 123 days (95% CI, 65-123 days), and 133 days (95% CI, 72-133 days). The median cumulative primary stent patency duration and patient survival did not differ significantly between the palliative group 119 days; (95% CI, 59-119 days), 128 days; (95% CI, 71-128 days), and the BTS group 120 days; (95% CI, 68-120 days; p = 0.362), 130 days; (95% CI, 78-130 days); p = 0.412).

CONCLUSIONS

The colorectal obstruction had convoluted with curved angulation and located mainly at the rectum, sigmoid, descending colon, and the radiologic method of SEMS placement has more efficacious with a high technical and clinical success rate. However, SEMS placement was highly technical, and clinical success with median stent patency and patient survival did not differ significantly between the palliative group and the BTS group.

Fluoroscopic Rescue of Failed Endoscopic Stent Placement for Obstructing Colorectal Malignancy

OBJECTIVE. This study evaluated the technical feasibility and clinical effectiveness of fluoroscopic stent placement in malignant colorectal obstructions after failed endoscopic stent placement. MATERIALS AND METHODS. Between January 2004 and December 2017, 41 patients with malignant colorectal obstructions were referred for fluoroscopic stent placement after failed endoscopy. The procedures were performed for palliation (n = 35) or as a bridge to surgery (n = 6). The technical and clinical success, complications, stent patency duration, and patient survival were retrospectively analyzed. RESULTS. Fluoroscopic stent placement was technically successful in 38 patients (92.7%). The causes of technical failure were complete obstruction (n = 1), redundant sigmoid colon (n = 1), and colon perforation (n = 1). Clinical success was achieved in 37 patients with technical success (97.4%). Major complications occurred in three patients (7.9%) and included colon perforation (n = 2) and anal pain (n = 1). The six patients with stenting as a bridge to surgery underwent elective colectomy uneventfully (100%). In 32 patients with technically successful palliative stenting, the median primary stent patency duration and patient survival were 353 days (95% CI, 162-353 days) and 335 days (95% CI, 116-335 days), respectively. CONCLUSION. Fluoroscopic colorectal stent placement is technically feasible and clinically effective in most patients with failed endoscopic procedures.

Radiologic Placement of Uncovered Stents for the Treatment of Malignant Colonic Obstruction Proximal to the Descending Colon

PURPOSE

To evaluate the safety, feasibility, and patency rates of radiologic placement of uncovered stents for the treatment of malignant colonic obstruction proximal to the descending colon.

MATERIALS AND METHODS

This was a retrospective, single-center study. From May 2003 to March 2015, 53 image-guided placements of uncovered stents (44 initial placements, 9 secondary placements) were attempted in 44 patients (male:female = 23:21; mean age, 71.8 years). The technical and clinical success, complication rates, and patency rates of the stents were also evaluated. Technical success was defined as the successful deployment of the stent under fluoroscopic guidance alone and clinical success was defined as the relief of obstructive symptoms or signs within 48 h of stent deployment.

RESULTS

In total, 12 (27.3 %) patients underwent preoperative decompression, while 32 (72.7 %) underwent decompression with palliative intent. The technical success rate was 93.2 % (41/44) for initial placement and 88.9 % (8/9) for secondary placement. Secondary stent placement in the palliative group was required in nine patients after successful initial stent placement due to stent obstruction from tumor ingrowth (n = 7) and stent migration (n = 2). The symptoms of obstruction were relieved in all successful cases (100 %). In the palliative group, the patency rates were 94.4 % at 1 month, 84.0 % at 3 months, 64.8 % at 6 months, and 48.6 % at 12 months.

CONCLUSIONS

The radiologic placement of uncovered stents for the treatment of malignant obstruction proximal to the descending colon is feasible and safe, and provides acceptable clinical results.

The efficacy of the coaxial technique using a 6-Fr introducer sheath in stent placement for treating the obstructions proximal to the descending colon

Objective

We wanted to evaluate the efficacy of stent placement using the coaxial technique with a stiff, long introducer sheath in patients with technical failure using an angiographic catheter for the obstructions proximal to the descending colon.

Materials and Methods

Self-expandable metallic stent placement was attempted under fluoroscopy-guidance in 77 consecutive patients who had malignant colorectal obstruction. Stent placement was performed using an angiographic catheter and a guide wire. If the angiographic catheter could not be advanced over the guide wire into the obstructive lesions proximal to the descending colon, then a 6-Fr introducer sheath was used. The technical success rate, the clinical success rate and the complications were analyzed.

Results

Successful stent placement was achieved in 75 of 77 patients (97%). The angiographic catheter failed to advance into the obstructive lesions of 11 patients (M:F = 7:4; mean age, 65.5 years) whose lesions were at the level of the splenic flexure or transverse colon. Therefore, the coaxial technique was implemented in all these 11 patients using a 6-Fr stiff introducer sheath and then the stent placement was successful. There were no complications related to the use of a stiff introducer sheath. Clinical success, which was defined as relief of clinical obstructive bowel symptoms, was obtained within 24 hours in all of patients.

Conclusion

The coaxial technique using a stiff introducer sheath can increase the technical success of fluoroscopy-guided, self-expandable metallic stent placement in patients with colonic obstruction proximal to the descending colon.