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AJR 2000; 175:1631-1637
© American Roentgen Ray Society

Malignant Colonic Obstruction Due to Extrinsic Tumor

Palliative Treatment with a Self-Expanding Nitinol Stent

Shiro Miyayama1, Osamu Matsui2, Koichi Kifune1, Masashi Yamashiro1, Toru Yamamoto1, Kiyohide Kitagawa3, Yoshio Kasahara4, Yasuyuki Asada4, Yoshiro Iida4 and Shoji Miura4

1 Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.
2 Department of Radiology, Kanazawa University Hospital, 13-1, Takara-machi, Kanazawa 920-8641, Japan.
3 Department of Radiology, Koseiren Takaoka Hospital, 5-10, Eiraku-cho, Takaoka 933-8555, Japan.
4 Department of Surgery, Fukuiken Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.

OBJECTIVE. The purpose of this study was to evaluate the usefulness of self-expanding nitinol stents for palliative treatment of malignant colorectal obstruction caused by unresectable extrinsic tumor, colorectal metastasis, or peritoneal seeding.

SUBJECTS AND METHODS. One covered stent and 10 uncovered stents were deployed in eight patients with colorectal obstruction due to extrinsic tumor under fluoroscopic guidance. The sites of obstruction were located in the rectum (n = 5), in the rectosigmoid colon (n = 2), and from the transverse colon to the descending colon (n = 1). Clinical usefulness and complications were analyzed.

RESULTS. Stents were placed successfully in all patients. Minor modifications of the delivery system were required in the tortuous rectosigmoid and lower rectum strictures. Symptoms of obstruction were initially resolved in all but one patient. In that patient, the presence of other points of obstruction was suspected. Bowel obstruction recurred in two patients: one obstruction was due to migration of a covered stent 4 days after the procedure, and the other obstruction was due to peritoneal seeding 33 days after the procedure. Both required colostomy or ileostomy. All patients died 12-111 days after stent placement (mean, 56 days). In five patients (63%), colonic obstruction was palliated by placing a stent until the patients' death between 39 and 111 days after stent placement (mean, 62 days). Six complications occurred in four patients and included stent migration (n = 1), anal bleeding (n = 2), anal pain that required analgesia (n = 1), and fever (n = 2).

CONCLUSION. This self-expandable nitinol stent adequately palliated 63% of patients with colonic obstruction due to extrinsic tumor in this small series. Patient selection is very important to the success of this treatment.


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