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2010 | 82 | 5 | 283-288
Tytuł artykułu

Preliminary Results of the use of Self-Expanding Nitinol Stents in Inoperable Gastrointestinal Cancers

Treść / Zawartość
Warianty tytułu
Języki publikacji
EN
Abstrakty
EN
The aim of the study was to present preliminary results of the palliative treatment of strictures and obstruction of the gastrointestinal tract in stage IV cancers with the use of self-expanding stents.Material and methods. Within a one-year period, from October 2007 to September 2009, stent implantation in the gastrointestinal tract was performed in 32 patients. Eligibility for palliative treatment was determined on the basis of a clinical examination and diagnostic tests to assess cancer stage. Each patient was assessed on the Karnofsky performance scale. The condition for eligibility, except for emergent circumstances, was performance status below 70. Endoscopy to collect biopsy samples for histopathologic examination and abdomen and chest CT scans were performed. Local advancement of cancer with infiltration of other tissues, such as metastases to the liver, distant lymph nodes or other organs, determined the choice of palliative treatment. Moreover, the presence and severity of coexisting disorders were also thoroughly examined. The procedures were performed using a c-arm X-ray system and endoscope. Following the introduction of the endoscope to the area of cancerous narrowing, a guide tube was inserted through the stricture under fluoroscopic control. Under combined endoscopic and radiological control, after contrast administration above the narrowing, a stent to expand the stricture was placed and released. The result of stent placement was documented by radiologic photographs, and a subsequent X-ray check was performed 48 hours after stent implantation.Results. A total of 33 stents were implanted in 32 patients. Problems with stent placement occurred in one patient. During implantation into a stricture secondary to sigmoid colon cancer, the stent slipped down and incompletely filled the tumor lumen. In this case, a short supplementary stent was added, which yielded a satisfactory result of the procedure. In another case, the stent migrated and adhered to the gastric wall, which further impaired passage through the patient's gastrointestinal tract. A feeding jejunostomy was performed in this patient, which was considered the best course due to the patient's extremely poor general condition.Conclusions. 1. Stent implantation in the gastrointestinal tract lumen in the setting of inoperable carcinomas under endoscopic and X-ray control is effective and safe. 2. In the case of gastrointestinal tract sub-obstruction in patients with left colon cancers and in poor general condition, this procedure should be considered prior to pursuing surgical operations.
Wydawca

Rocznik
Tom
82
Numer
5
Strony
283-288
Opis fizyczny
Daty
wydano
2010-05-01
online
2010-09-15
Twórcy
  • Department of General and Vascular Surgery, 2 Medical Faculty, Warsaw Medical University
  • Department of General and Vascular Surgery, 2 Medical Faculty, Warsaw Medical University
  • Department of General and Vascular Surgery, 2 Medical Faculty, Warsaw Medical University
  • Department of General and Vascular Surgery, 2 Medical Faculty, Warsaw Medical University
  • Gastrology Department, Food and Nutrition Institute in Warsaw
  • Gastrology Department, Food and Nutrition Institute in Warsaw
  • Gastrology Department, Food and Nutrition Institute in Warsaw
Bibliografia
  • Brehant O, Fuks D, Bartoli E et al.: Elective (planned) colectomy in patients with colorectal obstruction after placement of a self-expanding metallic stent as a bridge to surgery: the results of a prospective study. Colorectal Disease 2009; 11(2): 178-83.[Crossref][WoS]
  • McLoughlin MT, Byrne MF: Endoscopic stenting: where are we now and where we go? World J Gastroenterol 2008; 14(24): 3738-3803.
  • Vasileois Trompetas: Emergency management of malignant acute left-sided colonic obstruction. Annals of The Royal College of Surgeons of England 2008 Apr; 90(3): 181-86.[WoS]
  • Liberman H, Adams DR, Blatchford GJ et al: Clinical use of the self-expanding metallic stent in the management of colorectal cancer. Am J Surg 2000; 180(6): 407-11.[Crossref][PubMed]
  • Kim TH, Song HY, Park IK et al: Usefulness of multifunctional gastrointestinal coil catheter for colorectal stent placement. European Radiology 2008 Jun 4. (Epub ahead of print).[WoS]
  • Baerlocher MO, Asch MR, Vellahottam A et al: Safety and efficacy of gastrointestinal stents in cancer patients at a community hospital; Canadian J Surg 2008; 51(2): 130-34.
  • van Hoft JE, Focken P, Marinelli AW et al: Dutch Colorectal Stent Group; Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-aided colorectal cancer. Endoscopy 2008; 40(3): 184-91.[Crossref]
  • Vape P, Huhinen H, Rantala A et al: Adoption of self-expanding metallic stents in the palliative treatment of obstructive colorectal cancer-look out for perforations. Surgical Laparoscopy Endoscopy & Percutaneous Techniques 2008; 18(4): 353-56.[WoS]
  • Gupta K, Freeman ML: Enteral and colonic self-expanding metallic stents. Reviews in Gastroenterological Disorders 2008; 8(2): 83-97.[PubMed]
  • Dormann AJ, Deppe H, Wigginghaus B: Self-expanding metallic stents for continuous dilatation of benign stenoses in gastrointestinal tract - first results of long-term follow-up in interim stent application in pyloric and colonic obstructions. Gastroenterology 2001; 39: 957-60.
  • Harris GJC, Senagore AJ, Lavery JC et al.: The management of neoplastic colorectal obstruction with colonic endolumental stenting devices. Am J Surg 2001 181(6): 499-506.
  • Kim H, Kim SH, CHoi SY et al.: Fluoroscopically Guided Placement of Self-Expandable Metallic Stents and Stent-Grafts in the Treatment of Acute Malignant Colorectal Obstruction. Journal of Vascular Interventional Radiology 2008 Oct 7. (epub ahead of print).[Crossref][WoS]
  • Stenhouse GJ, Page B, McKelvi A et al: Self expanding wall stents in malignant colorectal cancer; is complete obstruction a contraindication to stent placement? Colorectal Disorders 2008 Aug 21; (epub ahead of print).[WoS]
Typ dokumentu
Bibliografia
Identyfikatory
Identyfikator YADDA
bwmeta1.element.-psjd-doi-10_2478_v10035-010-0040-y
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