scholarly journals Reocclusion after Self-Expandable Metallic Stent Placement for Relieving Malignant Colorectal Obstruction as a Palliative Treatment

2016 ◽  
Vol 10 (3) ◽  
pp. 733-742 ◽  
Author(s):  
Toshikatsu Nitta ◽  
Kensuke Fujii ◽  
Yoshimasa Hirata ◽  
Tomo Tominaga ◽  
Yoshihiro Inoue ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Stent Placement ◽  
Emergency Operation ◽  
Metallic Stent ◽  
Sems Placement ◽  
Laboratory Findings ◽  
Colorectal Obstruction ◽  
Expandable Metallic Stent ◽  
Old Japanese ◽  
Good Treatment Option

Self-expandable metallic stent (SEMS) placement has been practiced in several hospitals in Japan, including ours, since January 2012. Here, we report the case of an 82-year-old Japanese man who presented to the hospital with a 1-week history of right hypochondrial pain. Computed tomography (CT) findings indicated colorectal cancer. The laboratory findings on admission indicated severe anemia (red blood cell count, 426 × 104/μL; hemoglobin, 7.9 g/dL). We performed SEMS placement because the patient refused to undergo surgery. He did not attend any of the scheduled follow-up visits after SEMS placement. However, a year and a half after the SEMS placement, the patient attended the hospital because of difficulty in passing stool. A plain abdominal CT scan showed bowel reobstruction due to the ascending colon cancer after SEMS placement. We performed an emergency operation, ascending colostomy, on the same day. Colorectal stent placement may be a good treatment option for patients who refuse to undergo conventional therapeutic treatments or in those with unresectable colorectal cancer. Patients should be carefully followed up every few months after SEMS placement because of the risk of reocclusion.

Metallic Stent for Malignant Colorectal Obstruction

2018 ◽  
Vol 02 (01) ◽  
pp. 046-052
Author(s):  
Yoshitaka Inaba ◽  
Yozo Sato
Keyword(s):  
Stent Migration ◽  
Late Complications ◽  
Secondary Outcome ◽  
Successful Implementation ◽  
Metallic Stent ◽  
Bridge To Surgery ◽  
Success Rates ◽  
Sems Placement ◽  
Colorectal Obstruction ◽  
Expandable Metallic Stent

AbstractAcute colorectal obstruction has been often reported as a secondary outcome of left-colonic malignancy. It is considered as a common emergency condition. Self-expandable metallic stent (SEMS) placement is widely used as a palliative treatment for the management of malignant colorectal obstruction (MCRO). SEMS placement is also deliberated as a bridge to surgery. With advances in technology, several recent studies of SEMS placement for MCRO indicated high technical (94–98%) and clinical (91–93%) success rates. The complication rate associated with SEMS is quite acceptable. However, long-term outcomes are still unclear. The symptoms should be carefully monitored before application of SEMS, particularly in patients who are eligible for systemic chemotherapy and in patients with a long life expectancy because of late complications such as reobstruction, stent migration, and perforation. Appropriate patient selection and placement technique are keys for the successful implementation of SEMS.

Clinical outcomes in patients undergoing multiple self-expandable metallic stent placement by stent in stent technique for malignant gastric outlet obstruction.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 88-88
Author(s):  
Jinwon MO ◽  
Jie-Hyun Kim ◽  
Seung Yong Shin ◽  
Da Hyun Jung ◽  
Jae Jun Park ◽  
...  
Keyword(s):  
Gastric Outlet Obstruction ◽  
Stent Placement ◽  
Clinical Success ◽  
Outlet Obstruction ◽  
Metallic Stent ◽  
Sems Placement ◽  
Stent Patency ◽  
Malignant Gastric Outlet Obstruction ◽  
The Third ◽  
Expandable Metallic Stent

88 Background: Self-expandable metallic stent (SEMS) placement is widely used for relieving the obstructive symptoms of malignant gastric outlet obstruction (MGOO). The aims were to evaluate the efficacy and safety of multiple gastroduodenal stent placement by stent in stent technique and identify predictive factors about stent patency. Methods: We retrospectively analyzed data from 170 patients with GOO receiving SEMS by stent in stent technique from July 2006 to July 2018. Among them, 90 patients had been treated with gastroduodenal SEMS placement for MGOO. Technical and clinical success rates were evaluated. And, clinical outcomes with predictors of stent patency were also analyzed. Results: Among the subjects, 34.4% were treated with secondary SEMS placement, and 9.7% were treated with third SEMS placement because of the previous stent dysfunction. The median stent patency time was 15.7 weeks (range 0-89) in the first SEMS, 10.4 weeks (range 0-44) in the second SEMS, and 11.3 weeks (range 1-29) in the third SEMS. The technical and clinical success rate were 100% and 97.8% in the first SEMS, 100% and 90.3% in the second SEMS, 100% and 100% in the third SEMS. In multivariable analysis, the first SEMS placement of covered type including Comvi stent was correlated with prolonged stent patency (OR 4.549, P = 0.001). And both chemotherapy after the first SEMS placement (OR 8.248, P = 0.006) and chemotherapy after the second SEMS placement (OR 7.467, P = 0.003) were correlated with prolonged stent patency. Serious complications such as gastrointestinal hemorrhage or perforation did not occur in any patient. Conclusions: Secondary and third gastroduodenal SEMS placement by stent in stent technique is a safe and effective treatment for the first stent dysfunction in MGOO. The stent placement of covered type and chemotherapy after stent placement is the predictor of stent patency. Keywords: Malignant gastric outlet obstruction, Self-expandable metallic stent, Stent in stent technique, Stent patency, Predictive factor

scholarly journals Bridge to Surgery Using a Self-Expandable Metallic Stent for Stages II–III Obstructive Colorectal Cancer

2020 ◽  
Author(s):  
Katsuya Ohta ◽  
Masakazu Ikenaga ◽  
Masami Ueda ◽  
Kiyotsugu Iede ◽  
Yujiro Tsuda ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Venous Invasion ◽  
Stage Ii ◽  
Rank Test ◽  
Metallic Stent ◽  
Bridge To Surgery ◽  
Sems Placement ◽  
Obstructive Colorectal Cancer ◽  
Expandable Metallic Stent

Abstract Background: Bridge to surgery (BTS) using a self-expandable metallic stent (SEMS) for the treatment of obstructive colorectal cancer improves the patient’s quality of life. This study aimed to examine prognostic factors of obstructive colorectal cancer. Methods: We analyzed stage II-III resectable colon cancer cases (Cur A) retrospectively registered between January 2005 and 2017. We encountered Cur A cases after BTS with SEMS placement (BTS group). We compared surgical results and prognoses between the two groups. Results: A total of 50 patients underwent endoscopic SEMS placement, which technical success of 96% and morbidity rate of 18%. Overall, 117 patients were evaluated: 67 of them underwent emergency surgery (ES) and 50 underwent BTS. Primary anastomosis rates were 77.6% in ES and 95.7% in BTS (p < 0.001); postoperative complication, 46.3% in ES and 10.5% in BTS (p < 0.001); pathological findings of lymphatic invasion, 66.7% in ES and 100% in BTS (p < 0.001); venous invasion were 66.8% in ES and 92% in BTS (p = 0.04); and recurrence of 25.4% in ES and 39.1% in BTS. The 3-year overall survival was significantly different between two groups (ES, 86.8%:BTS, 58.8%), BTS is worse than ES (log-rank test; p < 0.001). Venous invasion independently predicted worsened recurrence-free and overall survival. Conclusions: The vascular invasiveness was correlated with tumor progression after SEMS placement, and the survival rate was lower in BTS. SEMS potentially worsens prognostic outcomes in stage II–III obstructive colorectal cancer.

scholarly journals Interwoven versus Knitted Self-Expandable Metallic Stents: A Comparison Study of Stent-Induced Tissue Hyperplasia in the Rat Esophagus

2021 ◽  
Vol 12 (1) ◽  
pp. 346
Author(s):  
Jeon Min Kang ◽  
Dongwook Oh ◽  
Song Hee Kim ◽  
Dae Sung Ryu ◽  
Yubeen Park ◽  
...  
Keyword(s):  
Stent Placement ◽  
Histologic Examination ◽  
Lower Percentage ◽  
Metallic Stent ◽  
Sems Placement ◽  
Luminal Diameter ◽  
Sems Group ◽  
Expandable Metallic Stent ◽  
Epithelial Layers ◽  
High Flexibility

This study investigated whether interwoven self-expandable metallic stent (I-SEMS) placement suppresses stent-induced tissue hyperplasia compared with conventional knitted self-expandable metallic stent (K-SEMS) placement in a rat esophageal model. Twelve rats were randomly assigned to the I-SEMS (n = 6) and K-SEMS (n = 6) groups. All rats were sacrificed 4 weeks after the stent placement. The degree of stent-induced tissue hyperplasia on esophagography and histologic examination was compared between the groups. Stent placement was technically successful in all rats. Esophagography revealed significantly greater mean luminal diameter of the stented esophagus in the I-SEMS group than in the K-SEMS group (p < 0.001). Histologic examination revealed a significantly lower percentage of tissue hyperplasia area and a significantly thinner submucosal fibrosis in the I-SEMS group than in the K-SEMS group (all p < 0.001). There were no significant differences in the thickness of the epithelial layers (p = 0.290) and degree of inflammatory cell infiltration (p = 0.506). Formation of stent-induced tissue hyperplasia was evident with both I-SEMS and K-SEMS. Placement of I-SEMSs with a small cell size and high flexibility seems to be effective in suppressing stent-induced tissue hyperplasia compared with placement of K-SEMSs in rat esophageal models.

scholarly journals Biopsy sampling during self-expandable metallic stent placement in acute malignant colorectal obstruction: a narrative review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sigrid Skov Bennedsgaard ◽  
Lene Hjerrild Iversen
Keyword(s):  
Cochrane Library ◽  
Unknown Etiology ◽  
Metallic Stent ◽  
Sems Placement ◽  
Colorectal Obstruction ◽  
Technical Success Rate ◽  
Expandable Metallic Stent ◽  
Real Risk ◽  
Acute Malignant Colorectal Obstruction ◽  
Risk Of Hemorrhage

Abstract Background Histopathology is a crucial part of diagnosis and treatment guidance of colorectal cancer. In Denmark, it is not routine to biopsy during self-expandable metallic stent (SEMS) placement as a treatment option for acute colorectal obstruction of unknown etiology. This is due to lack of knowledge about the risks of hemorrhage, and thus the risk to aggravate the deteriorating overview conditions. Therefore, the aim of this study is to investigate whether there is evidence to avoid biopsy sampling during acute SEMS placement. Methods The PubMed, Embase, and Cochrane Library databases were searched for relevant studies. Studies were included if they described biopsy sampling in relation to SEMS placement. Additionally, national and international guidelines were scrutinized on Google and by visiting the websites of national and international gastrointestinal societies. Results In total, 43 studies were included in the review. Among these, one recommended biopsy during SEMS placement, three advised against biopsy, 23 just reported biopsy was performed during the procedure, and 16 reported biopsy before or after the procedure, or the timing was not specified. Among the 12 included guidelines, only two described biopsy during SEMS placement. Conclusion The literature on the subject is limited. In 24 of the 43 included studies, biopsy sampling was done during SEMS placement without reporting a decrease in the technical success rate. The included guidelines were characterized by a general lack of description of whether biopsy during SEMS placement should be performed or not. Prospective studies are needed in order to establish the real risk of hemorrhage, if any, when a biopsy is obtained.

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