Stenting palliative

A number of other new therapeutic procedures have developed against the background of ERC, including the transpapillary insertion of stents for palliative bridging of ductal stenosis. 

Smith AC, Dowsett JF, Russell RC et al (1994) Randomised trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction. Lancet 344 1655-1660 Soehendra N, Reynders-Frederix V (1980) Palliative bile duct drainage - a new endoscopic method of introducing a transpapillary drain. Endoscopy 12 8-11... 

Metallic stents have an established place in the management of patients with esophageal cancer. Stents provide better relief of dysphagia than all of other palliative methods available. Complications as a result of stenting remain a problem and the search goes on for better devices. Coated devices may offer the solution in the future. 

Sanyika C, Corr P, Haffejee A (1999) Palliative treatment of oesophageal carcinoma - efficacy of plastic versus self-expandable stents. SAMJ 89 640-643 Saxon RR, Barton RE, Rosch J (1994) Complications of oesophageal stenting and balloon dilatation. Semin Intervent Radiol 11 276-282... 

In five recent series comprising 6-12 patients each (De Baere et aL 1997 Pinto 1997 Soetikno et al. 1998 Binkert et aL 1996 Feretis et al. 1996) various types of Wallstents were used (16-mm vascular rolling membrane, 20 to 22-mm oesophageal, 20 to 22 mm enteral Wallstents). Initial palliative success was achieved in 80%-100% (m=92%) of the total of 43 reported patients with a technical success rate of 83%-100% (m=95%). In all but four patients the stents were inserted via peroral route. Long-term follow-up was limited since most patients died within 6 months. Reobstruction rates varied from 8%-50% (m=25%) but secondary durable palliation until death or at the end of the study was achieved in 80%-100% (m=86%). 

The first stent implantations described by Dohmoto et al. in 1991 and Spinelli et al. in 1992 were endoscopic placements of self-expanding metallic stents for palliative treatment of colorectal cancer. Only later the preoperative stent placement for single-step surgery using radiologic techniques under fluoroscopy was first described as a technical note in two patients by Tejero et al. in 1994. The fundamental idea behind using preoperative stenting... 

Deans GT, Krukowski ZH, Irwing St (1994) Malignant obstruction in the left colon. Br J Surg 81 1270-6 De Baere T, Harry G, Ducreux M, Elias D, Briquet R, Kuoch V, Roche A (1997) Self-expanding metallic stents as palliative treatment of malignant gastro-duodenal stenosis. AJR 169 1079-1083... 

De Gregorio MA, Mainar A, Tobio R (1998) Acute colorectal obstructions stent placement for palliative treatment - results of a multicenter study. Radiology 209 117-120 De Lange EE, Shaffer HA (1991) Rectal strictures, treatment with fluoroscopically guided balloon dilatation. Radiology 178 475-479... 

Di Sario JA, Fennerty MB, Tietze CC (1994) Endoscopic balloon dilatation for ulcer-induced gastric outlet obstruction. Am J Gastroenterol 89 868-871 Dohmoto M (1991) New method-endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endoscopia Digestiva 3 1507-1512 Eckhauser ML (1992) Laser therapy of colorectal carcinoma. 

Grunshaw ND, Ball CS (2001) Palliative treatment of an enterorectal fistula with a covered metallic stent. Cardio-vasc Intervent Radiol 24 438-440 Herdeg C, Oberhoff M, Karsch KR (1998) Antiproliferative stent coatings Taxol and related compounds. Semin Interv Cardiol 3 197-199... 

Lee JM, Han YM, Lee SY (2001) Palliation of postoperative gastrointestinal anastomotic malignant structures with flexible covered metallic stents preliminary results. Cardiovasc Intervent Radiol 24 25-30 Lobato RF, Pinto I, Paul L (1999a) Self-expanding prostheses as a palliative method in treating advanced colorectal cancer. Int Surg 84 159-162... 

Tacke J, Antonucci F, Stuckmann G et al (1994) The palliative treatment of venous stenoses in tumor patients with selfexpanding vascular prostheses. ROFO 100 433-440 Tanigawa N, Sawada S, Mishima K et al. (1998) Clinical outcome of stenting in superior vena cava syndrome associated with malignant tumors. Comparison with conventional treatment. Acta Radiol 39 669-674 Trerotola SO (1994) Interventional Radiology in central venous stenosis and occlusion. Semin Interv Radiol 11 291-304... 

All types of metallic stents used in the ureter have produced similar results. An Austrian group reported the use of self-expanding Wallstent endoprostheses (Boston Scientific) for palliative treatment of malignant ureteral obstruction in 23 patients (30 ureters) (Lugm AYR and Pauer 1992). They used the following four criteria for patient selection (1) life expectancy of at least 6 months, (2) current chemotherapy, (3) increasing levels of serum creatinine and (4) severe clinical signs and symptoms associated with hydronephrosis. These were implanted endoscopically... 

Lugmayr H, Pauer W (1992) Self-expanding metal stents for palliative treatment of malignant ureteral obstruction. AJR Am J Roentgenol 159 1091-1094... 

Final choice of the stent should be done according to the clinical situation and the experience of the interventionist. In the case of non-malignant disease a metallic stent should be chosen with hesitation, especially if there is an inflammatory process that predisposes to induction of granulation tissue. In a palliative situation, metallic stents can... 

Experimental and clinical tracheal repair or anastomosis began in the late 19th century. A few examples of limited tracheal resection and primary anastomosis were cited in the first half of the 20th century [12]. Fmther experimental investigation on potential extent of tracheal resection and primary anastomosis without prosthesis greatly widened these possibilities. Approximately one-half of the adult trachea can be removed and primary reanastomosis performed [99—102], so most tracheal lesions can now be resected and primary anastomosed safely. But resection has several limitations in adult patients, only one-half the tracheal length can be successfully treated and only one-third in pediatric patients [7]. These patients are now treated with palliative techniques such as subpotent laser treatments and stents or T-tubes [14]. 

Schlensak C, Doenst T, Spillner G, Blum U, Geiger A, Bey-ersdorf F (2000) Palliative treatment of a secondary aor-toduodenal fistula by stent-graft placement. Thorac Car-diovasc Surg 48 41-42... 

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