Korean J Radiol.  2012 Feb;13(1):66-72. 10.3348/kjr.2012.13.1.66.

Dual-Design Expandable Colorectal Stent for a Malignant Colorectal Obstruction: Preliminary Prospective Study Using New 20-mm Diameter Stents

• Chou SQ
• Song HY
• Kim JH
• Park JH
• Fan Y
• Lee H
• Yoon YS
• Kim JC

• KMID: 1058795
• DOI: http://doi.org/10.3348/kjr.2012.13.1.66

Abstract

OBJECTIVE
To evaluate the safety and effectiveness of a 20-mm diameter dual-design expandable colorectal stent for malignant colorectal obstruction.
MATERIALS AND METHODS
The study series included 34 patients with malignant colorectal obstruction who underwent implantation of a 20-mm dual-design expandable colorectal stent in our department between March 2009 and June 2010. The 20-mm dual-design expandable colorectal stent was placed by using a 3.8-mm delivery system that had 28-mm diameter proximal and distal ends. Among the 34 patients, stent placement for palliation was performed in 20 patients, while stent placement for bridge to surgery was performed in 14 patients.
RESULTS
A 97% (33 of 34) success rate was achieved for the stent placement. The perforation rate in the bridge to surgery group was 7% (1 of 14), compared to 0% (0 of 19) in palliative group. Migration occurred in one of 33 patients (3%) at 30 days after stent placement.
CONCLUSION
The placement of a 20-mm diameter dual-design stent appears to be clinically safe and effective for the management of colorectal obstruction, with low perforation and migration rates.

Keyword

Colorectal cancer; Stent; Dual-design; Expandable

MeSH Terms

Adult
Aged
Aged, 80 and over
Colorectal Neoplasms/*complications
Female
Foreign-Body Migration/etiology
Humans
Intestinal Obstruction/*etiology/*therapy
Intestinal Perforation/etiology
Male
Middle Aged
Palliative Care
Prospective Studies
Prosthesis Design
*Stents
Treatment Outcome

Figure

• 

  Fig. 1 Photograph showing, from top to bottom, outer stent of dual stent, inner bare nitinol stent of dual stent, and bended inner bare nitinol stent.

• 

  Fig. 2 Illustration of patient with sigmoid colon cancer (patient 11). A. Water-soluble contrast study with sizing coil catheter during stent placement showing incomplete colonic obstruction. B. Plain radiograph obtained during placement of dual stent showing loaded distal stent. C. Plain radiograph obtained immediately after outer stent placement with loaded inner stent. D. Plain radiograph obtained immediately after stent placement of dual stent showing good flow of contrast medium through stent.

Reference

1. Song HY, Kim JH, Shin JH, Kim HC, Yu CS, Kim JC, et al. A dual-design expandable colorectal stent for malignant colorectal obstruction: results of a multicenter study. Endoscopy. 2007. 39:448–454.

2. Repici A, De Caro G, Luigiano C, Fabbri C, Pagano N, Preatoni P, et al. WallFlex colonic stent placement for management of malignant colonic obstruction: a prospective study at two centers. Gastrointest Endosc. 2008. 67:77–84.

3. Shin SJ, Kim TI, Kim BC, Lee YC, Song SY, Kim WH. Clinical application of self-expandable metallic stent for treatment of colorectal obstruction caused by extrinsic invasive tumors. Dis Colon Rectum. 2008. 51:578–583.

4. Repici A, Fregonese D, Costamagna G, Dumas R, Kahler G, Meisner S, et al. Ultraflex precision colonic stent placement for palliation of malignant colonic obstruction: a prospective multicenter study. Gastrointest Endosc. 2007. 66:920–927.

5. Fregonese D, Naspetti R, Ferrer S, Gallego J, Costamagna G, Dumas R, et al. Ultraflex precision colonic stent placement as a bridge to surgery in patients with malignant colon obstruction. Gastrointest Endosc. 2008. 67:68–73.

6. Fischer A, Schrag HJ, Goos M, Obermaier R, Hopt UT, Baier PK. Transanal endoscopic tube decompression of acute colonic obstruction: experience with 51 cases. Surg Endosc. 2008. 22:683–688.

7. Baron TH. Colonic stenting: technique, technology, and outcomes for malignant and benign disease. Gastrointest Endosc Clin N Am. 2005. 15:757–771.

8. Repici A, Pagano N, Hervoso CM, Danese S, Nicita R, Preatoni P, et al. Metal stents for malignant colorectal obstruction. Minim Invasive Ther Allied Technol. 2006. 15:331–338.

9. Breitenstein S, Rickenbacher A, Berdajs D, Puhan M, Clavien PA, Demartines N. Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction. Br J Surg. 2007. 94:1451–1460.

10. Dionigi G, Villa F, Rovera F, Boni L, Carrafiello G, Annoni M, et al. Colonic stenting for malignant disease: review of literature. Surg Oncol. 2007. 16:Suppl 1. S153–S155.

11. Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004. 99:2051–2057.

12. Khot UP, Lang AW, Murali K, Parker MC. Systematic review of the efficacy and safety of colorectal stents. Br J Surg. 2002. 89:1096–1102.

13. Camunez F, Echenagusia A, Simo G, Turegano F, Vazquez J, Barreiro-Meiro I. Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation. Radiology. 2000. 216:492–497.

14. Choo IW, Do YS, Suh SW, Chun HK, Choo SW, Park HS, et al. Malignant colorectal obstruction: treatment with a flexible covered stent. Radiology. 1998. 206:415–421.

15. Jung GS, Song HY, Kang SG, Huh JD, Park SJ, Koo JY, et al. Malignant gastroduodenal obstructions: treatment by means of a covered expandable metallic stent-initial experience. Radiology. 2000. 216:758–763.

16. Grunshaw ND, Ball CS. Palliative treatment of an enterorectal fistula with a covered metallic stent. Cardiovasc Intervent Radiol. 2001. 24:438–440.

17. Law WL, Choi HK, Chu KW. Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg. 2003. 90:1429–1433.

18. Kang SG, Jung GS, Cho SG, Kim JG, Oh JH, Song HY, et al. The efficacy of metallic stent placement in the treatment of colorectal obstruction. Korean J Radiol. 2002. 3:79–86.

19. Kim JH, Song HY, Li YD, Shin JH, Park JH, Yu CS, et al. Dual-design expandable colorectal stent for malignant colorectal obstruction: comparison of flared ends and bent ends. AJR Am J Roentgenol. 2009. 193:248–254.

20. Mainar A, De Gregorio Ariza MA, Tejero E, Tobio R, Alfonso E, Pinto I, et al. Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery--results of a multicenter study. Radiology. 1999. 210:65–69.

21. Liberman H, Adams DR, Blatchford GJ, Ternent CA, Christensen MA, Thorson AG. Clinical use of the self-expanding metallic stent in the management of colorectal cancer. Am J Surg. 2000. 180:407–411. discussion 412.

22. Meisner S, Hensler M, Knop FK, West F, Wille-Jorgensen P. Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center. Dis Colon Rectum. 2004. 47:444–450.

23. de Gregorio MA, Mainar A, Tejero E, Tobio R, Alfonso E, Pinto I, et al. Acute colorectal obstruction: stent placement for palliative treatment--results of a multicenter study. Radiology. 1998. 209:117–120.

24. Xinopoulos D, Dimitroulopoulos D, Theodosopoulos T, Tsamakidis K, Bitsakou G, Plataniotis G, et al. Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis. Surg Endosc. 2004. 18:421–426.

25. Scurtu R, Barrier A, Andre T, Houry S, Huguier M. [Self-expandable metallic stent for palliative treatment of colorectal malignant obstructions: risk of perforation]. Ann Chir. 2003. 128:359–363.

26. van Hooft JE, Fockens P, Marinelli AW, Timmer R, van Berkel AM, Bossuyt PM, et al. Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy. 2008. 40:184–191.

27. Small AJ, Baron TH. Comparison of Wallstent and Ultraflex stents for palliation of malignant left-sided colon obstruction: a retrospective, case-matched analysis. Gastrointest Endosc. 2008. 67:478–488.

28. Kim JH, Song HY, Hu HT, Kang YK, Jung HY, Yook JH, et al. Palliative treatment of malignant gastric outlet obstructions with a large-diameter metallic stent: prospective preliminary study. J Vasc Interv Radiol. 2010. 21:1125–1128.