title: Malignant intestinal obstruction: useful technical advice in self-expanding metallic stent placement.
abstract: BACKGROUND
  The use of endoluminal self-expanding metallic stents is an effective alternative to surgery in neoplastic gastrointestinal tract obstructions. It is often difficult to mark the proximal segment of the stricture under fluoroscopic guidance (due to patient movements or change of markers' position).
  
  
  METHODS
  We placed Ultraflex precision colonic stent (Microvasive, Boston Scientific) in ten patients with neoplastic stricture of the rectosigmoid colon. Before placement of the delivery catheter, a radiopaque proximal marker was identified on the delivery catheter under fluoroscopic guidance. The external side of the delivery catheter was coloured (in correspondence with the radiopaque marker) with non toxic colour. After the introduction of the delivery catheter, we placed the proximal coloured marker just above the distal tumour margin under endoscopic guidance.
  
  
  RESULTS
  The procedure was successful in relieving the obstruction in all patients, without mortality or complications. In all patients the coloured marker was identified and the stent correctly placed.
  
  
  CONCLUSIONS
  The location of a coloured marker in the external side of the delivery catheter permits an accurate and correct placement of the stent, without unnecessary exposure to X-rays.
authors.affiliation: Department of Surgery Pietro Valdoni, University of Rome, La Sapienza, Italy. Enrico.Fiori@uniroma1.it
authors.forename: Enrico
authors.initials: E
authors.lastname: Fiori
authors.forename: Antonietta
authors.initials: A
authors.lastname: Lamazza
authors.forename: Antonio
authors.initials: A
authors.lastname: Burza
authors.forename: Massimo
authors.initials: M
authors.lastname: Meucci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cavallaro
authors.forename: Luciano
authors.initials: L
authors.lastname: Izzo
authors.forename: Alberto
authors.initials: A
authors.lastname: Schillaci
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cangemi
mesh_terms: D002404:Catheterization / Q000379:methods; D012809:Colon, Sigmoid / Q000601:surgery; D003110:Colonic Neoplasms / Q000150:complications* / Q000601:surgery; D005471:Fluoroscopy; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D012004:Rectal Neoplasms / Q000150:complications* / Q000601:surgery; D015607:Stents