Outcomes of Colonic Stenting Using a Specifically Designed Expandable Metal Colonic Stent (Ultraflex™ Precision)

Abstract

Outcomes of Colonic Stenting Using a Specifically Designed Expandable Metal Colonic Stent (Ultraflex Precision) Jose G. de la Mora, Todd Baron, Christopher Gostout, Nicole Pochron Background: Colonic stenting is now accepted for obstructing lesions, either as a temporary or definitive treatment. Until now, studies have used stents not designed specifically for use in the colon. The Ultraflex Precision stent is designed specifically for the colon, with a larger diameter (25 vs 20 mm), proximal flare (30 mm) and atraumatic ends. The aim of this study is to describe the results using this stent at our institution. Material & Methods: A retrospective review of patients that underwent placement of this stent (S), were included. Variables were: diagnosis, site, need for dilation, use of fluoroscopy, S length, placement success, complications, follow-up and final outcome. Results: 38 S were placed in 30 patients. In 6 cases 2 S were used and 3 S in one patient. Diagnosis was: cancer in 23, post-radiation in 2 and 1 each for: diverticular stricture, crohn’s, extrinsic tumor, anastomotic stricture and pancreatitis with colonic involvement. 13 lesions were located in descending colon, 15 in rectosigmoid and 2 in transverse. S lengths used were 5.7 cm (10), 8.7 cm (20) and 11.7 cm (8). Fluoroscopy was used in 28 patients with endoscopic control in 23. No dilatation was performed in 26; in 3 cases dilatation was performed after deployment . Placement success was 27/30 (90%) with two misplaced & repositioned S, and 1 that failed to expand. Severe pain occurred in 6 cases, evident perforation in 2 and suspected perforation (with late abscess formation) in 2 patients. One pt. experienced bacteremia with fever. Both evident perforations occurred in cancer pts. , The two cases with abscess formation occurred in benign disease (pancreatitis and post-radiation). Colostomy was performed in 2 and conservative treatment in two, one of which died from disease progression. Follow-up was available in 24, for a mean of 2 months (1-180 days). No stent malfunction was seen in 21 (2 abscess excluded) up to proctocolectomy (in 5) or death from disease progression (in 4). One stent required trimming. One intraoperative perforation occurred at the stent site. Conclusions: Placement success is similar to previous series using other types of stents not specifically designed for the colon. No migrations occurred, and other complications presented also at a similar rate. The later cases could be due to the fact that they were not neoplastic, although the increased diameter of the new stents cannot be excluded as an additional factor. Abstracts