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Novel method of stent insertion for malignant lower rectal obstruction with proximal releasing delivery system (with video).

Lee, KM  | Lim, SG  | Shin, SJ  | Kim, JH  | Kang, DH | Kim, JK  | Hwang, JC  | Kwon, CI | Cheong, JY  | Yoo, BM
Gastrointestinal endoscopy, 78(6). : 930-933, 2013
Journal Title
Gastrointestinal endoscopy
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).

DESIGN: Prospective clinical series outcome study.

SETTING: A tertiary-care referral university hospital.

PATIENTS: 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.

INTERVENTION: Uncovered stent with the PRDS with endoscopic and fluoroscopic guidance.

MAIN OUTCOME MEASUREMENTS: 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.

LIMITATIONS: 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.
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Gastroenterology
Journal Papers > School of Medicine / Graduate School of Medicine > Radiology
Ajou Authors
김, 재근  |  김, 진홍  |  신, 성재  |  유, 병무  |  이, 기명  |  임, 선교  |  정, 재연  |  황, 재철
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