Korean J Radiol.  2012 Feb;13(Suppl 1):S83-S88. 10.3348/kjr.2012.13.S1.S83.

Usefulness of a Guiding Sheath for Fluoroscopic Colorectal Stent Placement

• Song HY
• Nam DH
• Lee H

• KMID: 1372872
• DOI: http://doi.org/10.3348/kjr.2012.13.S1.S83

Abstract

OBJECTIVE
To investigate the technical feasibility, clinical usefulness, and safety of a guiding sheath in fluoroscopic stent placement for patients with malignant colorectal obstructions.
MATERIALS AND METHODS
Between June 2007 and January 2011, fluoroscopic placement of a dual colorectal stent was attempted in a total of 97 patients with malignant colorectal obstructions. A polytetrafluoroethylene guiding sheath was used in patients in whom a stent delivery system failed to reach the obstruction. Usefulness of the sheath was evaluated depending on whether the sheath could successfully assist the stent delivery system reach its area of interest.
RESULTS
The guiding sheath was needed in 22 patients (15 men, 7 women; age range, 33-77 years; mean age, 59 years). The overall success rate for passing the sheath to the area of interest was 100%. There were no procedure-related deaths or major complications. The majority of the patients reported mild discomfort. In 2 of 22 patients with successful passing of the sheath to the area of interest, stent placement failed because of failure in the negotiation of a guide wire through the obstruction.
CONCLUSION
Using a guiding sheath seems to be easy, safe and useful in fluoroscopic stent placement for patients with malignant colorectal obstructions.

Keyword

Colon; Interventional procedure; Stenosis or obstructions; Stents and prostheses

MeSH Terms

Adult
Aged
Colorectal Neoplasms/*surgery
Equipment Safety
Feasibility Studies
Female
Fluoroscopy
Humans
Intestinal Obstruction/*surgery
Male
Middle Aged
Polytetrafluoroethylene
*Stents
Treatment Outcome

Figure

• 

  Fig. 1 Photographs of guiding sheath and stent delivery system. Photograph shows guiding sheath (A), distal end (B) of stent delivery system (arrows) loaded in sheath (curved arrows), and proximal end (C) of stent delivery system (arrows) loaded in sheath (curved arrows).

• 

  Fig. 2 Radiographs obtained before and during stent placement in patient with recurrent gastric cancer involving middle portion of transverse colon. A. Barium study before stent placement shows near complete obstruction (arrow). B. Radiograph obtained during negotiation of coil catheter (arrowheads) with guide wire (arrow) shows tortuous sigmoid colon (curved arrows). C. Straightening of sigmoid colon using guiding sheath with stiff guide wire (arrows). D. Radiograph obtained just prior to passage of stent delivery system for coaxial placement of inner bare stent into outer stent (arrowheads). Note radiopaque tip (arrow) of sheath located in descending colon. E. Water soluble contrast media study immediately after placement of stent shows good flow of contrast medium through stent (arrowheads). Note radiopaque tip (arrow) of sheath located in descending colon.

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