nitinol and Intestinal-Obstruction

Topics: Alloys; Anastomosis, Surgical; Endoscopes; Endoscopy; Female; Follow-Up Studies; Humans; Intestinal Obstruction; Middle Aged; Neoplasm Recurrence, Local; Sigmoid Neoplasms; Stents

Emergency surgery for malignant colon obstruction entails relatively high morbidity and mortality rates and typically necessitates a 2-step resection. These problems might be potentially mitigated by placement of a self-expanding metal stent (SEMS) as a bridge to surgery. A nitinol colorectal SEMS may offer several advantages, but available evidence on the utility of this SEMS type remains highly limited.. Our purpose was to evaluate the effectiveness and safety as a bridge to surgery of a nitinol SEMS designed for colorectal use.. Prospective and retrospective multicenter clinical study.. Sixteen European study centers.. Thirty-six patients with malignant colonic obstruction.. Nitinol colorectal SEMS placement.. Technical success in accurate SEMS placement with coverage of the entire stricture length, clinical success in alleviating colonic obstructive symptoms, and bridging to elective surgery.. Technical success was achieved in 97% of patients with a 95% CI of 85% to 100% and clinical success in 81% (95% CI, 64%-92%). Elective surgery was performed in 94% (95% CI, 81%-99%) of patients at a median of 11 days (95% CI, 7-15 days) after SEMS placement. SEMS-related perforation occurred in 3 patients.. No control group was included in this nonrandomized cohort study.. In this first comparatively large clinical study of a nitinol colorectal SEMS as a bridge to surgery, a high proportion of patients successfully proceeded to elective surgery after prior decompression by SEMS placement.

Topics: Adenocarcinoma; Adult; Alloys; Colonic Neoplasms; Decompression, Surgical; Duodenal Diseases; Female; Humans; Intestinal Obstruction; Male; Prospective Studies; Prosthesis Design; Prosthesis Implantation; Retrospective Studies; Stents

Many patients who develop obstructive colonic symptoms secondary to inoperable colorectal cancer will require palliative treatment. A minimally invasive and potentially long-lasting approach is placement of nitinol self-expanding metal stents (SEMS).. To determine the effectiveness and safety of a nitinol SEMS designed for colorectal use in the palliative treatment of malignant colonic obstruction.. Prospective multicenter clinical study.. Nine European study centers.. Forty-four patients with malignant colonic obstruction.. Placement of nitinol SEMS designed for colorectal use.. Technical success, defined as accurate SEMS deployment with adequate stricture coverage, and clinical success, defined as decompression and relief of obstructive colonic symptoms maintained without intervention or serious device-related complications.. Technical success was attained in 95% of patients, with 95% CI 85%-99%. After 6 months, the rate of clinical success was 81%, 95% CI 69%-96%. Survival at 6 months was 67%, 95% CI 54%-84%. Clinical success was maintained until death in 86% of the nonsurvivors. No perforations or SEMS-related deaths occurred.. This investigation was nonrandomized and did not include a control group.. In a large prospective investigation, palliative placement of a nitinol SEMS designed for colorectal use was accomplished with a high rate of technical success. Durable clinical success was achieved in a high proportion of patients with low morbidity.

Topics: Aged; Aged, 80 and over; Alloys; Colon; Colonic Neoplasms; Female; Humans; Intestinal Obstruction; Male; Palliative Care; Prospective Studies; Prosthesis Implantation; Stents; Survival Rate

Currently applied endoscopic palliative treatment of advanced rectosigmoidal carcinoma is hampered by the cost of the equipment, the need for repeated, often painful treatment sessions, and the occurrence of complications. Metallic expandable stents are effective in the palliation of malignant esophageal and biliary stenoses. We evaluated the use of a new type of self-expandable nitinol stent in the palliation of rectosigmoidal carcinoma.. In 10 patients with advanced obstructing rectosigmoidal carcinoma, initial Nd:YAG laser treatment was performed if necessary to allow passage of a gastroscope. Subsequently, a self-expanding nitinol stent with flanged ends was inserted under combined fluoroscopic and endoscopic control. Endoscopic and clinical follow-up was carried out at regular intervals.. After 2+/-0.4 sessions of initial laser therapy, minimal lumen diameter was 9+/-1 mm. Stent insertion was successful in 9 patients, increasing minimal lumen diameter to 14+/-1.2 mm (p < 0.005). In one patient, stent deployment was complicated by a sigmoid perforation, requiring surgery. After insertion, colorectal stents remained adequately positioned and free of obstruction for 103+/-31 days. Patient survival after stent placement was 204 +/-43 days. Stent migration occurred in 3 patients, after 38+/-10 days. Obstruction of the stent because of tumor ingrowth was observed in only one patient, after 268 days.. Insertion of self-expandable nitinol stents in patients with rectosigmoidal carcinoma is technically feasible. Metallic stents are effective in the palliation of malignant rectosigmoid obstruction; they provide an alternative to repeated palliative laser therapy or palliative surgery.

Topics: Aged; Aged, 80 and over; Alloys; Endoscopes, Gastrointestinal; Endoscopy, Gastrointestinal; Equipment Design; Female; Follow-Up Studies; Humans; Intestinal Obstruction; Male; Palliative Care; Radiography; Rectal Neoplasms; Sigmoid Neoplasms; Stents; Survival Rate; Treatment Outcome

Compared to emergency surgery, self-expandable metallic stents are effective and safe when used as bridge-to-surgery (BTS) in operable patients with acute colorectal cancer obstruction. In this study, we report data on the new conformable colonic stents.. To evaluate clinical effectiveness of conformable stents as BTS in patients with acute colorectal cancer obstruction.. This was a retrospective study.. The study was conducted at six Italian Endoscopic Units.. Data about patients with acute malignant colorectal obstruction were collected between 2007 and 2012.. All patients were treated with conformable stents as BTS. Technical success, clinical success, rate of primary anastomosis and colostomy, early and late complications were evaluated.. Data about 88 patients (62 males) were reviewed in this study. Conformable SEMS were correctly deployed in 86 out of 88 patients, with resolution of obstruction in all treated patients. Tumor resection with primary anastomosis was possible in all patients. A temporary colostomy was performed in 40. Early complications did not occur. Late complications occurred in 11 patients. Stent migration was significantly higher in patients treated with partially-covered stents compared to the uncovered group (35% vs. 0%, P<0.001). Endoscopical re-intervention was required in 12% of patients. One patient with rectal cancer had an anastomotic dehiscence after surgery and he was successfully treated with endoscopic clipping. One year after surgery, all patients were alive and local recurrence have not been documented.. This was a retrospective and uncontrolled study.. Preliminary data from this large case series are encouraging, with a high rate of technical and clinical success and low rate of clinically relevant complications. Partially-covered SEMS should be avoided in order to reduce the risk of endoscopic re-intervention.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Coated Materials, Biocompatible; Colorectal Neoplasms; Endoscopy, Digestive System; Female; Humans; Intestinal Obstruction; Male; Middle Aged; Polytetrafluoroethylene; Retrospective Studies; Self Expandable Metallic Stents

Self-expandable metal stents (SEMS) are a nonsurgical option for treatment of malignant colorectal obstruction also as a bridge to surgery approach. The new nitinol conformable stent has improved clinical outcomes in these kinds of patients. We report a pilot experience with nitinol conformable SEMS placement as bridge to surgery treatment in patients with colorectal obstruction.. Between April and August 2012, we collected data on colonic nitinol conformable SEMS placement in a cohort of consecutive symptomatic patients, with malignant colorectal obstruction, who were treated as a bridge to surgery. Technical success, clinical success, and adverse events were recorded.. Ten patients (7 male (70%)), with a mean age of 69.2±10.1, were evaluated. The mean length of the stenosis was 3.6±0.6 cm. Five patients (50%) were treated on an emergency basis. The median time from stent placement to surgery was 16 days (interquartile range 7-21). Technical and clinical success was achieved in all patients with a significant early improvement of symptoms. No adverse events due to the SEMS placement were observed.. This pilot study confirmed the important role of nitinol conformable SEMS as a bridge to surgery option in the treatment of symptomatic malignant colorectal obstruction.

Topics: Aged; Alloys; Colonic Neoplasms; Female; Humans; Intestinal Obstruction; Male; Metals; Middle Aged; Pilot Projects; Prospective Studies; Prosthesis Design; Stents; Treatment Outcome

Topics: Aged; Alloys; Colonic Diseases; Colonic Neoplasms; Colonoscopy; Female; Hospitals, Military; Humans; Intestinal Obstruction; Male; Middle Aged; Morocco; Palliative Care; Radiography, Interventional; Retrospective Studies; Stents

Endoscopic colonic stenting with self-expanding metallic stents is now widely used to treat malignant large bowel obstruction, where temporary or permanent decompression of the large bowel is desired. The medical records of patients who underwent endoscopic colonic stenting for malignant large bowel obstruction between May 2004 and May 2011 were reviewed. Success rate, morbidity, and mortality rate along with patient characteristics were documented. Sixty-seven patients were included. The procedure was used as a bridge to surgery in 38 and as a palliative measure in 29. Success rate was 95.5 per cent. Perforation and reobstruction occurred in three and three patients, respectively. All of the patients who developed perforation or reobstruction underwent emergency surgery. Endoscopic stenting offers a safe and effective treatment option in patients with malignant large bowel obstruction with comparable outcomes.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Colorectal Neoplasms; Decompression, Surgical; Endoscopy; Female; Humans; Intestinal Obstruction; Male; Middle Aged; Prosthesis Design; Retrospective Studies; Stents; Treatment Outcome

Self-expandable metallic stents (SEMS) of varying designs and materials have been developed to reduce complications, but few comparative data are available with regard to the type of stent and the stent manufacturer. We analyzed the success rates and complication rates, according to stent type (uncovered vs. covered stent) and individual stent manufacturer, in malignant colorectal obstruction.. From November 2001 to August 2008, 103 patients were retrospectively included in this study: four types of uncovered stents in 73 patients and two types of covered stents in 30 patients. The SEMS was inserted into the obstructive site by using the through-the-scope method.. Technical and clinical success rates were not different between stent type or among stent manufacturers: 100 and 100% (p = ns) and 100 and 96.6% (p > 0.05), respectively, in uncovered and covered stents. Stent occlusion and migration rates were 12.3 and 3.3% (p = 0.274) and 13.7 and 16.7% (p = 0.761), respectively, in uncovered and covered stents, and 11.1, 5, and 9% (p = 0.761) and 25.9, 15, and 0% (p = 0.037) in Wallstent, Niti-S, and Bonastent uncovered stents, respectively.. The placement of SEMS is an effective and safe treatment for patients with malignant colorectal obstruction. Although minor differences in outcome were detected according to the type and the manufacturer of the stents, no statistically significant difference was observed, except in stent migration among the stent manufacturer.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Alloys; Carcinoma; Chromium Alloys; Coated Materials, Biocompatible; Cobalt; Colonic Diseases; Colonic Neoplasms; Colonoscopy; Equipment Design; Female; Fluoroscopy; Foreign-Body Migration; Humans; Intestinal Obstruction; Male; Middle Aged; Palliative Care; Pancreatic Neoplasms; Radiography, Interventional; Rectal Diseases; Stents; Stomach Neoplasms; Treatment Outcome; Uterine Cervical Neoplasms

A 12-year-old castrated male Labrador Retriever was evaluated for clinical signs associated with colorectal obstruction.. The dog had a 2-week history of tenesmus and hematochezia. On rectal examination, an annular colorectal mass was palpable extending orad into the pelvic canal. The original diagnosis of the colorectal mass was a mucosal adenoma. The dog was maintained on a low-residue diet and fecal softeners for a period of 13 months after initial diagnosis. At that time, medical management was no longer effective.. Placement of a colonic stent was chosen to palliate the clinical signs associated with colorectal obstruction. By use of fluoroscopic and colonoscopic guidance, a nitinol stent was placed intraluminally to open the obstructed region. Placement of the stent resulted in improvement of clinical signs, although tenesmus and obstipation occurred periodically after stent placement. At 212 days after stent placement, the patient had extensive improvement in clinical signs with minimal complications; however, clinical signs became severe at 238 days after stent placement, and the dog was euthanized. Histologic evaluation of the rectal tumor from samples obtained during necropsy revealed that the tumor had undergone malignant transformation to a carcinoma in situ.. A stent was successfully placed in the colon and rectum to relieve obstruction associated with a tumor originally diagnosed as a benign neoplasm. Placement of colorectal stents may be an option for the palliation of colorectal obstruction secondary to neoplastic disease; however, clinical signs may persist, and continuation of medical management may be necessary.

Topics: Alloys; Animals; Carcinoma in Situ; Colorectal Neoplasms; Dog Diseases; Dogs; Intestinal Obstruction; Male; Palliative Care; Stents

Self-expanding metal stents (SEMSs) can alleviate malignant colonic obstruction and avoid emergency decompressive surgery. The use of colonic larger-diameter SEMSs may improve bowel function and reduce migration risk.. To evaluate the effectiveness and safety of a novel large-diameter SEMS (WallFlex) designed for delivery through the endoscope in treating malignant colonic obstruction.. Prospective clinical cohort study.. Two Italian study centers.. Forty-two consecutive patients with malignant colonic obstruction: 23 requiring palliation and 19 bridging to surgery.. Colorectal SEMS placement.. Technical success, defined as accurate SEMS deployment across the stricture on the first attempt; clinical success, ie, complete relief of bowel obstruction without complications; and bridging to surgery, denoting the performance of elective one-stage surgery.. The rate of technical success was 93% (95% CI, 81%-99%) and of initial clinical success was 95% (95% CI, 84%-99%). In 58% (95% CI, 40%-84%) of the palliation group, clinical success was maintained after 6 months. All 19 patients with operable tumors were successfully bridged to one-stage elective surgery within a median of 5 days. One perforation and one stent migration occurred. All complications could be resolved nonsurgically.. No control group was included.. In a prospective study of through-the-scope WallFlex stent placement for malignant colonic obstruction, high rates of technical and initial clinical success, and bridging to surgery were achieved. Complications could be readily managed.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Alloys; Colon, Sigmoid; Colonic Neoplasms; Constriction, Pathologic; Female; Humans; Intestinal Obstruction; Male; Middle Aged; Prospective Studies; Prosthesis Design; Sigmoid Diseases; Stents

The endoscopic placement of metallic stents for palliation of malignant obstruction of the GI or biliary tract is an established practice and as such is often applied. Use of these stents, however, has its problems. Stent migration may cause obstruction of the bowel lumen. Migration of a biliary stent into the contralateral duodenal wall may cause difficulty in gaining access to the biliary tract, as will the placement of a duodenal stent across the ampulla.. We report on 6 patients in whom trimming of the metallic nitinol stent was performed.. Single-center, retrospective case series.. Secondary referral center.. Of 6 patients included, 2 patients each had an uncovered duodenal stent, 2 had an uncovered biliary stent each, 1 had an uncovered colorectal stent, and 1 had a covered gastroduodenal stent.. Under direct endoscopic vision, an argon plasma beam was used to cut self-expandable metallic stents, as appropriate.. The main objective was relief of the obstruction to the bowel lumen or bile duct, facilitating successful passage of an endoscope or biliary canulation, respectively.. In all 5 patients with uncovered metallic stents, we were able to re-establish access to the obstructed bowel lumen or the biliary tree, as indicated. An attempt to tailor the length of a covered metallic gastroduodenal stent failed. No complications were observed and no hemorrhage or perforation occurred.. The study was limited by retrospective design and small sample size.. The endoscopic cutting and tailoring of an uncovered metallic prosthesis, by means of an argon plasma beam, is feasible, effective, and safe. Trimming of covered stents is not advocated.

Topics: Adenocarcinoma; Aged; Alloys; Argon; Biliary Tract Neoplasms; Device Removal; Electrosurgery; Endoscopy, Gastrointestinal; Female; Foreign-Body Migration; Humans; Intestinal Obstruction; Male; Middle Aged; Pancreatic Neoplasms; Stents

The use of self-expanding metallic stents (SEMS) as esophageal endoprosthesis represents an advancement in the palliation of dysphagia from unresectable esophageal carcinoma. However, the problem of stent migration persists. Although most migrated stents have a benign outcome, complications do occur. Rare reports of intestinal obstruction have been confined to the stiff plastic and stainless-steel stents. We report the first case of intestinal obstruction secondary to the pliable Nitinol SEMS (Ultraflex) migration.

Topics: Adenocarcinoma; Aged; Alloys; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Deglutition Disorders; Device Removal; Epirubicin; Equipment Design; Esophageal Neoplasms; Fluorouracil; Foreign-Body Migration; Humans; Ileal Diseases; Intestinal Obstruction; Laparotomy; Liver Neoplasms; Male; Postoperative Complications; Stents

Topics: Adenocarcinoma; Aged; Alloys; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Fatal Outcome; Humans; Intestinal Obstruction; Laparotomy; Male; Palliative Care; Pneumonia, Aspiration; Prosthesis Failure; Radiography, Abdominal; Stents

Insertion of metallic stents for esophageal stenoses is well established, but these stents are technically difficult to place elsewhere in the GI tract. Moreover, major complications have occurred when metal stents with sharp ends have been placed in these locations. The currently available flexible, blunt-ended, knitted nitinol stent is intended for use only in the esophagus. Because its short delivery system cannot reach segments of the gut distal to the esophagus, the delivery device was modified to facilitate intestinal access, and its performance was evaluated in the treatment of malignant intestinal obstructions.. The Ultraflex delivery system was modified by connecting an additional plastic tube and a suture cord; the length was increased from 95 cm to 150 cm or more. Stents used were 18 to 23 mm in diameter, and 10 to 15 cm in length. A knitted metal stent was inserted by using the modified delivery system in 10 patients (7 men, 3 women, mean age 68 years); 8 with gastric outlet, 1 with jejunal, and 1 with proximal colonic obstruction.. Metal stent insertion was successful in all patients with significant relief of symptoms and restoration of the ability to eat. The patient with a jejunal stent required placement of a second stent because of bending of the initial stent. No major complications (migration or perforation) occurred.. This technique appears to facilitate placement of a metal stent with blunt ends in the duodenum, small intestine, and proximal colon. Manufacturers should offer blunt-ended stents with long delivery devices.

Topics: Aged; Alloys; Equipment Design; Female; Gastric Outlet Obstruction; Humans; Intestinal Obstruction; Male; Stents

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.. 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.. 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.

Topics: Alloys; Colonic Diseases; Colorectal Neoplasms; Female; Humans; Intestinal Obstruction; Male; Middle Aged; Neoplasms; Palliative Care; Patient Selection; Peritoneal Neoplasms; Rectal Diseases; Stents

Topics: Aged; Alloys; Bile Duct Neoplasms; Cholestasis, Extrahepatic; Fatal Outcome; Follow-Up Studies; Foreign-Body Migration; Hepatic Duct, Common; Hernia, Inguinal; Humans; Intestinal Obstruction; Intestine, Small; Male; Prosthesis Failure; Radiography; Reoperation; Rupture; Stents

Topics: Aged; Alloys; Constriction, Pathologic; Dilatation; Esophageal Neoplasms; Esophageal Stenosis; Humans; Intestinal Obstruction; Male; Rectal Diseases; Rectal Neoplasms