Keywords:
Abdomen, Colon, Interventional non-vascular, Fluoroscopy, Stents, Cancer, Obstruction / Occlusion, Multidisciplinary cancer care
Authors:
B. Rathinavelu1, R. George1, S. K. Agarwal2, H. Heather1, G. Dhanesh1, T. Amarnath1; 1Chesterfield/UK, 2Wrexham, Wa/UK
DOI:
10.1594/ecr2013/C-0752
Results
Eighty-one colorectal stent procedures were performed between October 2006 and October 2012. All procedures were carried out in radiology department as combined endoscopic and fluoroscopic approach by a Colorectal Surgeon and a Radiologist. Five Colorectal Surgeons were involved in the series, with one Radiologist for all cases. Age ranged between 56 and 98 years. Thirty procedures were performed as emergency for acute obstruction,
6 for locally advanced fistulating tumours,
11 as bridge to surgery and 34 for obstructive symptoms. Covered ComVi colonic stent (Taewoong Medical,Korea) was used for fistulating tumours and uncovered Wallflex colonic stent (Boston Scientific,USA) was used for the rest.
Our technical success rate was 90% and clinical success rate was 88.5%. Two cases of perforation were identified, one of which was clinically insignificant (tiny perforation identified on the post-operative histological specimen). Second case of perforation occurred 5 days after the stenting in a friable tumour. The screening time ranged between 3.6 minutes and 30.1 minutes with an average screening time of 14 minutes.
Technique:
Initial planning was carried out using multiplanar reformats of CT scan (Fig.1&2).
A dual channel therapeutic gastroscope was used to identify the level of the tumour. The malignant stricture was then crossed with a 260cm long hydrophilic wire and cannulated. The stricture was delineated using iodinated contrast (Fig.3) and stented (Fig.4) through the scope (TTS technique). The biopsies were performed through second channel before deployment of the stent.