Use of an Expandable Ultraflex Stent in the Treatment of Malignant Rectal Stricture

Abstract

Obstructive colorectal cancer is usually an indication for surgical intervention. For patients with metastatic disease, medical contraindications, or those who refuse surgery, palliation by nonoperative means is necessary. The advent of expandable metallic stents may allow for speedy palliation. We have treated one patient with unresectable colon cancer with a new selfexpanding endoprosthesis made of nitinol (Ultraflex, Microvasive, Watertown, MA, U.S.A.).

Palliative Treatment of Malignant Colorectal Strictures with Metallic Stents

“…Despite stent migration, neither of the patients suffered from constipation during follow-up. There have also been other reports of migration, with and without recurrence of blockage [10,12]. In our experience, the dilative effect of the stent on the stricture may persist for quite some time after migration, and for that reason immediate replacement may not be called for after expulsion of a palliative stent from the colon.…”

“…Unlike reports on other types of stent by other authors [10,12], balloon dilatation was not required either before or after insertion in our cases using Wallstents. Incomplete expansion of the stent was observed only in a single case 24 hr after release, but it did not prevent complete resolution of the clinical symptoms of obstruction.…”

Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction

“…But several studies suggest that it may be associated with higher rates of anastomotic dehiscence and wound infection. 8,9 Insertions of SEMS have become a popular procedure for preoperative decompression for palliative treatment in operable or inoperable malignant colorectal obstruction. [10][11][12][13] In our study, overall technical success and clinical efficacy rates were 97.5% (78/80) and 98.7% (77/78), respectively.…”

“…[5][6][7] SEMS can be used as a palliative treatment and, before surgery, for 1-stage operation, without emergency colostomy for colorectal obstruction. [7][8][9][10][11] SEMS can be classified into 2 types: uncovered and covered. Both types of stents have their own merits and demerits.…”

Role of colonoscopy in colorectal cancer

“…In the remaining 13 patients, bowel prep was considered adequate during the operation. Perforation, migration, pain, and tumor overgrowth represent the main obstacles for stent treatment, and results of flexible metallic mesh prosthesis insertion need further evaluation 96 .…”