An experience of colonic stent placement using a proximal release type stent

Abstract

We report the japan's first experience of proximal release type colonic stent designed at our department, for malignant stenosis of the lower rectal stricture by peritoneal dissemination of gastric cancer. A 50s female developed malignant rectal obstruction during chemotherapy for peritoneal dissemination following the surgery for gastric cancer, and she was referred to our hospital for colonic stent placement. On admission, her colorectal obstruction scoring system (CROSS) score was 0, and decompression had been performed by transanal urethral balloon catheter placement at the former institution. For the colonic stent placement, via the same catheter, a 0.035 inch Fr RevoWave ultra-hard guidewire was placed, and after endoscopic observation and fluoroscopic imaging, a marking clip was placed, and then a Niti-S colonic stent- proximal stent 22×70 mm was placed. There were no complications observed during stent placement, and the following day, oral intake was started and transferred to her previous clinic for ongoing chemotherapy. For the stent placement for rectal stricture, if the distal edge of the stent locate touch to the dentate line, it willhighly likely cause of pain, and thus it is important to select the appropriate stent length while taking into account the length of stenosis as well as the distance from the anal verge. In addition, it is also important that the stent placement site is neither excessive nor insufficient. The presently developed proximal release type stent enables the distal side of the stent position to accurately match the marking clip, and we believe that it will be useful in stent placement for malignant stenosis of the lower rectum. The ColoRectal Obstruction Scoring System (CROSS) of the Japan Colonic Stent Safe Procedure Research Group is available to the public on their home page (http://colon-stent.com). This group recommends the CROSS, an objective score, to evaluate the patient's condition preoperatively, and to indicate and evaluate decompression methods.