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

Abstract

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.