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Preliminary Results of the use of Self-Expanding Nitinol Stents in Inoperable Gastrointestinal Cancers

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Miłek T., Ciostek P., Woźniak W., Lewczuk A., Petryka R., Słowik J., Jarosz M.

Polish Journal of Surgery

2010

vol. 82

issue 5

283-288

The aim of the study was to present preliminary results of the palliative treatment of strictures and obstruction of the gastrointestinal tract in stage IV cancers with the use of self-expanding stents.Material and methods. Within a one-year period, from October 2007 to September 2009, stent implantation in the gastrointestinal tract was performed in 32 patients. Eligibility for palliative treatment was determined on the basis of a clinical examination and diagnostic tests to assess cancer stage. Each patient was assessed on the Karnofsky performance scale. The condition for eligibility, except for emergent circumstances, was performance status below 70. Endoscopy to collect biopsy samples for histopathologic examination and abdomen and chest CT scans were performed. Local advancement of cancer with infiltration of other tissues, such as metastases to the liver, distant lymph nodes or other organs, determined the choice of palliative treatment. Moreover, the presence and severity of coexisting disorders were also thoroughly examined. The procedures were performed using a c-arm X-ray system and endoscope. Following the introduction of the endoscope to the area of cancerous narrowing, a guide tube was inserted through the stricture under fluoroscopic control. Under combined endoscopic and radiological control, after contrast administration above the narrowing, a stent to expand the stricture was placed and released. The result of stent placement was documented by radiologic photographs, and a subsequent X-ray check was performed 48 hours after stent implantation.Results. A total of 33 stents were implanted in 32 patients. Problems with stent placement occurred in one patient. During implantation into a stricture secondary to sigmoid colon cancer, the stent slipped down and incompletely filled the tumor lumen. In this case, a short supplementary stent was added, which yielded a satisfactory result of the procedure. In another case, the stent migrated and adhered to the gastric wall, which further impaired passage through the patient's gastrointestinal tract. A feeding jejunostomy was performed in this patient, which was considered the best course due to the patient's extremely poor general condition.Conclusions. 1. Stent implantation in the gastrointestinal tract lumen in the setting of inoperable carcinomas under endoscopic and X-ray control is effective and safe. 2. In the case of gastrointestinal tract sub-obstruction in patients with left colon cancers and in poor general condition, this procedure should be considered prior to pursuing surgical operations.

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1 Polish Journal of Surgery

1 2010

1 Ciostek P.

1 Jarosz M.

1 Lewczuk A.

1 Miłek T.

1 Petryka R.

1 Słowik J.

1 Woźniak W.

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Preliminary Results of the use of Self-Expanding Nitinol Stents in Inoperable Gastrointestinal Cancers