Feasibility of a new self-expandable metallic stent for patients with malignant colorectal obstruction.
OBJECTIVE
Stent migration due to peristalsis of the colon is one of the unresolved complications of colonic self-expandable metallic stent (SEMS) placement. Axial force (AF), a recovery force of the stent to a straight position after bending, has been considered a factor influencing the conformability of the digestive tract. An uncovered SEMS (Niti-S Enteral Colonic Uncovered Stent, D-type; Taewoong, Inc., Gimpo, South Korea) with improved conformability is considered to decrease migration.


METHODS
Thirty three consecutive patients with symptomatic colorectal obstruction between March 2006 and December 2011 underwent endoscopic stent placement for palliation to estimate the efficacy and safety of Niti-S stents prospectively in four tertiary referral centers.


RESULTS
Technical and clinical success rates were 100% and 97%, respectively. Seventeen patients had the following complications: ingrowth (n = 6), overgrowth (n = 1), collapse of the SEMS (n = 1), stool impaction (n = 2), migration (n = 1), bleeding (n = 3), and tenesmus (n = 3). The patient with migration had no recurrent symptoms until death. Of these 17 patients, 10 required re-interventions. Seven patients underwent an additional SEMS implantation. One patient underwent surgery for stoma creation. Two patients had stool impaction, and they underwent endoscopic cleaning. The median duration of patency was 347.0 ± 65.5 days. The mean survival time after stent insertion was 240.1 ± 39.9 days.


CONCLUSIONS
The new SEMS effectively relieves malignant colorectal obstruction. Good conformability, according to the very low AF, may contribute to the low incidence of migration.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Shuntaro
S
Yoshida
Hirotsugu
H
Watabe
Hiroyuki
H
Isayama
Hirofumi
H
Kogure
Yousuke
Y
Nakai
Natsuyo
N
Yamamoto
Takashi
T
Sasaki
Kazumichi
K
Kawakubo
Tsuyoshi
T
Hamada
Yukiko
Y
Ito
Yoko
Y
Yashima
Naoki
N
Sasahira
Kenji
K
Hirano
Yutaka
Y
Yamaji
Minoru
M
Tada
Masao
M
Omata
Kazuhiko
K
Koike
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D011474:Prosthesis Design; D015607:Stents
D008670:Metals