Palliation With Endoluminal Stents Todd H. Baron, M.D., F.A.C.P. Professor of Medicine...
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Palliation With Endoluminal Palliation With Endoluminal StentsStents
Todd H. Baron, M.D., F.A.C.P.Todd H. Baron, M.D., F.A.C.P.
Professor of MedicineProfessor of Medicine
Gastroenterology & HepatologyGastroenterology & Hepatology
Mayo Clinic College of MedicineMayo Clinic College of Medicine
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Enteral StentsEnteral Stents
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Malignant Gastric Outlet Malignant Gastric Outlet ObstructionObstruction
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Clinical SituationsClinical Situations• Unresectable CAUnresectable CA
pancreatic, GB, Cholangiopancreatic, GB, Cholangio• Metastatic diseaseMetastatic disease• Local invasion - colonLocal invasion - colon• Gastric CAGastric CA• primaryprimary•RecurrentRecurrent
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SEMS: OverviewSEMS: Overview
• May be placed endoscopically or May be placed endoscopically or radiologicallyradiologically
• Non-TTS difficult but possibleNon-TTS difficult but possible
• TTS placement - can be placed TTS placement - can be placed beyond ligament of Treitz - beyond ligament of Treitz - uncovereduncovered
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WallstentWallstent
• Delivery diameter: Delivery diameter: 10F10F
• Deployed diameter: Deployed diameter:
20mm20mm
22mm22mm
• TTSTTS
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ENDO ENDO GASTRO-JGASTRO-J p p
Number of patients Number of patients 1212 15 15
Median survival (days) Median survival (days) 9494 9292 NS NS
Median charges incurred Median charges incurred $9921 $9921 $28,173 $28,173 < 0.005 < 0.005
Median hospitalizationMedian hospitalization stay required (days) stay required (days) 4 4 14 14 < 0.005< 0.005
Number requiring repeat procedures Number requiring repeat procedures and hospitalization and hospitalization 7 (58.3%) 7 (58.3%) 15 (100%) 15 (100%)
Yim, et al., GIE, 2001Yim, et al., GIE, 2001
Cost of Palliation: Pancreatic CACost of Palliation: Pancreatic CA
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Malignant Colorectal Malignant Colorectal ObstructionObstruction
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Metal Colonic StentsMetal Colonic Stents• Wilson-Cook Z stentWilson-Cook Z stent
• Microvasive WallstentMicrovasive Wallstent
• Precision Ultraflex ColonicPrecision Ultraflex Colonic
OTHEROTHER• Ultraflex Esophageal StentUltraflex Esophageal Stent
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Colonic Z-StentColonic Z-Stent
• Delivery diameter:Delivery diameter:
10mm (30F)10mm (30F)
• Deployed diameter: Deployed diameter: 35/25mm35/25mm
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Indications for Colorectal StentsIndications for Colorectal Stents
• Pre-operativePre-operative
• PalliativePalliative
• IndeterminateIndeterminate
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Potential Benefits ofPotential Benefits ofPre-operative Colon StentsPre-operative Colon Stents
• One-stage operationOne-stage operation
• Reduced costsReduced costs
• Improved QOLImproved QOL
• Elective operationElective operation
• Pre-operative assessmentPre-operative assessment
tumor resectabilitytumor resectability
patient operabilitypatient operability
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Complications of Enteral Stents Complications of Enteral Stents • Tumor ingrowth/overgrowthTumor ingrowth/overgrowth
• MigrationMigration
• PerforationPerforation
immediateimmediate
delayeddelayed
• Impaction Impaction
• BleedingBleeding
• Pain/TenesmusPain/Tenesmus
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ConclusionsConclusions• SEMS are effective for closing TEF and SEMS are effective for closing TEF and
treating all forms of malignant treating all forms of malignant esophageal obstructionesophageal obstruction
• SEMS are cost-effective for palliation of SEMS are cost-effective for palliation of malignant GOO for pancreatic CAmalignant GOO for pancreatic CA
• SEMS can be used for both pre-SEMS can be used for both pre-operative and palliative treatment of operative and palliative treatment of malignant colonic obstruction malignant colonic obstruction