Novel method of stent insertion for malignant lower rectal obstruction with proximal releasing delivery system (with video).
BACKGROUND
Self-expandable metal stents are an alternative to preoperative and palliative colostomy for patients with malignant colorectal obstruction. However, self-expandable metal stent placement is considered unsuitable or contraindicated for patients with malignant lower rectal obstruction within 5 cm of the anal verge because the exposed stent portion can irritate the distal rectum and cause anal pain and a foreign body sensation.


OBJECTIVE
To describe our experience with 6 patients with malignant lower rectal obstruction who underwent stent insertion with a proximal releasing delivery system (PRDS).


METHODS
Prospective clinical series outcome study.


METHODS
A tertiary-care referral university hospital.


METHODS
This study involved all patients at our center who had a malignant lower rectal obstruction within 5 cm of the anal verge caused by rectal cancer and bladder cancer.


METHODS
Uncovered stent with the PRDS with endoscopic and fluoroscopic guidance.


METHODS
Technical and clinical success rate, adverse event rate, and stent migration rate.


RESULTS
All stents were placed at the expected location. Technical and clinical success rates were 100%. Two patients reported anal pain, which was controlled with analgesics. One case of tumor ingrowth occurred after 5 months and was treated with reinsertion of a stent with the PRDS. After stent insertion, the patients received chemotherapy, chemoradiotherapy, or conservative care.


CONCLUSIONS
Small number of patients and no comparison group. Further prospective, randomized, controlled trials are needed.


CONCLUSIONS
Uncovered stent insertion with the PRDS is a feasible, safe, and effective treatment for the patient with malignant lower rectal obstruction within 5 cm from the anal verge.
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea; Korean Society of Gastrointestinal Stent Research Group, Seoul, South Korea.
Kee Myung
KM
Lee
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Sun Gyo
SG
Lim
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Sung Jae
SJ
Shin
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Jin Hong
JH
Kim
Korean Society of Gastrointestinal Stent Research Group, Seoul, South Korea; Department of Internal Medicine, Pusan National University School of Medicine, Pusan, South Korea.
Dae Hwan
DH
Kang
Department of Radiology, Ajou University School of Medicine, Suwon, South Korea.
Jae Keun
JK
Kim
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Jae Chul
JC
Hwang
Korean Society of Gastrointestinal Stent Research Group, Seoul, South Korea; Department of Internal Medicine, CHA University School of Medicine, Seoul, South Korea.
Chang-Il
CI
Kwon
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Jae Yeon
JY
Cheong
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Byung Moo
BM
Yoo
D000368:Aged; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012004:Rectal Neoplasms / Q000150:complications*; D015607:Stents / Q000009:adverse effects; D001749:Urinary Bladder Neoplasms / Q000150:complications*
PRDS; SEMS; proximal releasing delivery system; self-expandable metal stent