The Efficacy of the Coaxial Technique Using a 6-Fr Introducer Sheath in Stent Placement for Treating the Obstructions Proximal to the Descending Colon

Abstract

ObjectiveWe 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 MethodsSelf-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.ResultsSuccessful 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.ConclusionThe 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.

Comparison of Clinical Outcomes between Endoscopic and Radiologic Placement of Self-expandable Metal Stent in Patients with Malignant Colorectal Obstruction

“…17,18 In addition, when the obstructive lesion is located at or proximal to the descending colon, the tortuous, curved anatomy of the left colon and the shortness of the catheter make it difficult to even reach the lesion using the radiologic method alone. 19 While various devices, such as the multifunctional gastrointestinal coil catheter, 19 Balkin sheath, 8 and shuttle sheath 20 have been introduced in an attempt to overcome the limitations of placing an angiographic catheter proximal to the descending colon and to prevent the prolapse into the greater curvature of the tortuous, curved sigmoid or descending colon, the limitations of stent insertion using these devices must still be accepted as part of the general procedure because those studies included relatively small numbers of patients and were conducted by interventional radiologists with limited experience. There have even been some reports suggesting that stent placement is more difficult to perform in the descending colon or splenic flexure than in the rectum or sigmoid colon.…”