Expandable Metal Stent Placement for Malignant Colorectal Obstruction

Abstract

ObjectivesMost outcome data for placement of self-expanding metal stents (SEMS) within the gastrointestinal tract comes from experience of their use within the esophagus and biliary tree. In 1992, Spinelli et al. first reported placement of a modified Gianturco-Rösch stent within the colon for management of large bowel obstruction, and a large amount of data has accrued concerning SEMS use within the large bowel. The goal of this article is to define the clinical indications for insertion of SEMS for colonic obstruction, the types of stents used, the techniques of insertion, and the outcomes. Basic PrinciplesColorectal SEMS may be placed under endoscopic guidance, with or without the aid of fluoroscopy, by endoscopists, or by interventional radiologists using only fluoroscopic guidance. The advantages of endoscopic placement of SEMS over placement by interventional radiology arise because of the greater accessibility to these sites and the improved mechanical advantage of being able to pass some stents directly through the working channel of the endoscope ("through the scope" [TTS]). This advantage is especially found when the obstruction is proximal to the rectosigmoid, or in patients with very angulated rectosigmoid anatomy [1,2]. Interventional radiologists, however, have much more experience both in the finer points of passing guide wires through obstructive lesions and in deploying SEMS. Although many of the principles for placement of SEMS for colonic obstruction apply to both endoscopic and radiological insertion, this article will focus on the endoscopic techniques of placement.

Laparoscopic Sigmoid Resection After Placement of Stent for Acute Colonic Obstruction: Report of a Case

“…Hastaların sol kolon obstrüksiyonu için yapılan acil cerrahi müdahale sonrası yoğun bakımda kalış süresi anlamlı ölçüde artmaktadır. [10] Law ve ark. nın sol yerleşimli tıkayıcı tümörlerde acil ameliyat ile stent yerleştirmeyi kıyaslayan çalışmada 61 hastanın 31'ine cerrahi ve 30'una stent uygulamışlar ve maliyet etkinlik bakımından stent uygulamanın acil ameliyata üstünlüğü gösterilmiştir.…”

“…[4] Stent sonrası cerrahide ameliyat sonrası ağrı, analjezik ihtiyacı, yara yeri enfeksiyonu, primer anastomoz sonrası kaçak oranı anlamlı ölçüde daha azdır. [2,10] Bizim olgumuzda stent uygulanmasına ait herhangi bir komplikasyon gelişmeyip ameliyat sonrası dönemide sorunsuz geçerek yedinci gün taburcu edildi. Yaygın olarak görülen ameliyat sonrası komplikasyonların maliyeti ile kıyaslandığında stentlemenin maliyeti cost efektif bir alternatiftir.…”

“…Yaygın olarak görülen ameliyat sonrası komplikasyonların maliyeti ile kıyaslandığında stentlemenin maliyeti cost efektif bir alternatiftir. [10] Sonuç olarak, kolon kaynaklı tümör nedeniyle oluşan obstrüksiyonlarda stent uygulanması ilk dekompresyonu sağlayıp stomadan kaçınmayı sağlamakta ve acil operasyonu mekanik bağırsak hazırlığı sonrasında planlı ve güvenli cerrahiye çevirmektedir.…”

Self-expanding metal stents versus antrectomy for the palliative treatment of obstructive adenocarcinoma of the gastric antrum

“…While laparoscopic gastrojejunostomy is less invasive, adequate gastrointestinal function can also be delayed for a similar period, with this approach (9). Gastric stents are less invasive than surgery, allow for shorter hospital stays and earlier oral intake (10). There are a number of studies that compare palliative endoscopy with surgical treatment; however, most of them include patients with malignant GOO secondary to a variety of malignancies, including gastric, duodenal and biliopancreatic tumors.…”

Endoscopic Placement of a Biliary Expandable Metal Stent Through the Mesh Wall of a Duodenal Stent

“…Biliary stenting following duodenal stenting across the papilla usually requires a percutaneous transhepatic approach [1,4,5]. We report a case in which a biliary SEMS was placed endoscopically through the mesh wall of a previously inserted duodenal SEMS.…”