J Korean Soc Radiol.  2012 Dec;67(6):433-440. 10.3348/jksr.2012.67.6.433.

A Dual Expandable Stent for Treatment of Malignant Colorectal Obstruction: Long-Term Follow-Up Results

• Son W
• Kang H
• Jung GS

• KMID: 2097978
• DOI: http://doi.org/10.3348/jksr.2012.67.6.433

Abstract

PURPOSE
To analyze the long-term results and to evaluate the efficacy of a dual expandable stent for the treatment of malignant colorectal strictures.
MATERIALS AND METHODS
Under the fluoroscopic guidance, stents were placed in 60 patients with malignant colorectal strictures. A dual stent consists of two stents, the outer stent was placed into the stricture which was followed by coaxial placement of the inner bare stent. Technical and clinical success rates, complications, patient survival and stent patency during the follow-up period were evaluated in this study.
RESULTS
Stent placement was technically successful in 57 of 60 patients (95%). Of them, obstructive symptoms resolved within two days in 12/12 (100%) patients in the preoperative group and in 36/45 (80%) patients in the palliative group. Complications associated with this procedure were perforation (n = 5), migration (n = 3), and tumor overgrowth (n = 2). Each of the six patients in the preoperative group underwent conventional laparotomy and laparoscopic surgery, respectively. The mean interval between stent insertion and surgery was nine days. In the palliative group, the median survival was 159 days (mean; 235) and the median patency of stent was 116 days (mean; 185). 1-month, 3-month, 6-month, 12-month and 24-month stent patency were 75%, 60%, 27%, 13% and 7%, respectively.
CONCLUSION
Insertion of a dual expandable nitinol stent into malignant colorectal obstruction is a safe and effective procedure for the palliative treatment of malignant colorectal obstruction. This procedure is also effective for preoperative decompression.

MeSH Terms

Alloys
Colorectal Neoplasms
Constriction, Pathologic
Decompression
Follow-Up Studies
Humans
Intestinal Obstruction
Laparoscopy
Laparotomy
Palliative Care
Stents
Alloys

Figure

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  Fig. 1 Photographs of dual expandable nitinol stent. A. An outer partially covered stent. B. An inner bare nitinol stent. C. An assembled dual expandable nitinol stent.

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  Fig. 2 Sigmoid colon cancer in a 43-year-old man. A. Contrast enhanced axial CT image shows a focal mucosal thickening and apple-core like luminal narrowing in the sigmoid colon (arrows). B. Double contrast barium study shows a total obstruction at the sigmoid colon (arrow). C. Abdominal plain radiograph obtained two days after the procedure shows full expansion of the stent (arrow) and normal pattern of bowel gas. D. Follow-up sigmoidoscopy shows the patent stented lumen.

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  Fig. 3 Ovarian cancer with colon metastasis in a 68-year-old woman. A. A plain radiograph obtained two days after the procedure shows the expanded stent in left upper quadrant of the abdomen (arrow). B. Contrast enhanced CT scan obtained five days after the procedure shows that distal portion of the stent abuts against the bowel wall, causing perforation (arrow). C. Photograph of the specimen obtained at emergency surgery 5 days after stent insertion shows the perforation site (arrow).

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  Fig. 4 Kaplan-Meier estimation of patient survival rate.

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  Fig. 5 Kaplan-Meier estimation of stent patency rate.

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