Tertiary stent-in-stent for obstructing colorectal cancer: A case report and literature review.
Bevacizumab
Case report
Colorectal neoplasms
Intestinal obstruction
Palliative care
Self-expandable metallic stents
Journal
World journal of gastrointestinal endoscopy
ISSN: 1948-5190
Titre abrégé: World J Gastrointest Endosc
Pays: United States
ID NLM: 101532474
Informations de publication
Date de publication:
16 Jan 2019
16 Jan 2019
Historique:
received:
29
10
2018
revised:
05
12
2018
accepted:
13
12
2018
entrez:
2
2
2019
pubmed:
2
2
2019
medline:
2
2
2019
Statut:
ppublish
Résumé
Self-expandable metal stents (SEMSs) are frequently used in the setting of palliation for occluding, inoperable colorectal cancer (CRC). Among possible complications of SEMS positioning, re-obstruction is the most frequent. Its management is controversial, potentially involving secondary stent-in-stent placement, which has been poorly investigated. Moreover, the issue of secondary stent-in-stent re-obstruction and of more-than-two colonic stenting has never been assessed. We describe a case of tertiary SEMS-in-SEMS placement, and also discuss our practice based on available literature. A 66-year-old male with occluding and metastatic CRC was initially treated by positioning of a SEMS, which had to be revised 6 mo later when a symptomatic intra-stent tumor ingrowth was treated by a SEMS-in-SEMS. We hereby describe an additional episode of intestinal occlusion due to recurrence of intra-stent tumor ingrowth. This patient, despite several negative prognostic factors (splenic flexure location of the tumor, carcinomatosis with ascites, subsequent chemotherapy that included bevacizumab and two previously positioned stents (1 SEMS and 1 SEMS-in-SEMS)) underwent successful management through the placement of a tertiary SEMS-in-SEMS, with immediate clinical benefit and no procedure-related adverse events after 150 d of post-procedural follow-up. This endoscopic management has permitted 27 mo of partial control of a metastatic disease without the need for chemotherapy discontinuation and, ultimately, a good quality of life until death. Tertiary SEMS-in-SEMS is technically feasible, and appears to be a safe and effective option in the case of recurrent SEMS obstruction.
Sections du résumé
BACKGROUND
BACKGROUND
Self-expandable metal stents (SEMSs) are frequently used in the setting of palliation for occluding, inoperable colorectal cancer (CRC). Among possible complications of SEMS positioning, re-obstruction is the most frequent. Its management is controversial, potentially involving secondary stent-in-stent placement, which has been poorly investigated. Moreover, the issue of secondary stent-in-stent re-obstruction and of more-than-two colonic stenting has never been assessed. We describe a case of tertiary SEMS-in-SEMS placement, and also discuss our practice based on available literature.
CASE SUMMARY
METHODS
A 66-year-old male with occluding and metastatic CRC was initially treated by positioning of a SEMS, which had to be revised 6 mo later when a symptomatic intra-stent tumor ingrowth was treated by a SEMS-in-SEMS. We hereby describe an additional episode of intestinal occlusion due to recurrence of intra-stent tumor ingrowth. This patient, despite several negative prognostic factors (splenic flexure location of the tumor, carcinomatosis with ascites, subsequent chemotherapy that included bevacizumab and two previously positioned stents (1 SEMS and 1 SEMS-in-SEMS)) underwent successful management through the placement of a tertiary SEMS-in-SEMS, with immediate clinical benefit and no procedure-related adverse events after 150 d of post-procedural follow-up. This endoscopic management has permitted 27 mo of partial control of a metastatic disease without the need for chemotherapy discontinuation and, ultimately, a good quality of life until death.
CONCLUSION
CONCLUSIONS
Tertiary SEMS-in-SEMS is technically feasible, and appears to be a safe and effective option in the case of recurrent SEMS obstruction.
Identifiants
pubmed: 30705733
doi: 10.4253/wjge.v11.i1.61
pmc: PMC6354113
doi:
Types de publication
Case Reports
Langues
eng
Pagination
61-67Déclaration de conflit d'intérêts
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Références
Br J Surg. 2003 Nov;90(11):1429-33
pubmed: 14598426
Surg Endosc. 2004 Mar;18(3):421-6
pubmed: 14735348
Anticancer Res. 2004 Jan-Feb;24(1):265-8
pubmed: 15015606
Am J Gastroenterol. 2004 Oct;99(10):2051-7
pubmed: 15447772
Dis Colon Rectum. 2004 Sep;47(9):1455-61
pubmed: 15486741
Surg Endosc. 2004 Nov;18(11):1572-7
pubmed: 15931483
Dis Colon Rectum. 2007 Oct;50(10):1568-75
pubmed: 17687610
Endoscopy. 2008 Mar;40(3):184-91
pubmed: 18322873
Clin Gastroenterol Hepatol. 2009 Nov;7(11):1174-6
pubmed: 19631290
Dig Dis Sci. 2010 Jun;55(6):1732-7
pubmed: 19693667
Int J Colorectal Dis. 2010 Jan;25(1):91-6
pubmed: 19859722
Am J Gastroenterol. 2010 May;105(5):1087-93
pubmed: 19935785
Colorectal Dis. 2011 May;13(5):512-8
pubmed: 20128833
Gastrointest Endosc. 2010 Mar;71(3):560-72
pubmed: 20189515
Gastrointest Endosc. 2011 Sep;74(3):625-33
pubmed: 21762906
Gastrointest Endosc. 2011 Oct;74(4):858-68
pubmed: 21862005
Arch Surg. 2011 Oct;146(10):1157-62
pubmed: 22006874
Digestion. 2013;88(1):46-55
pubmed: 23880524
Surg Today. 2014 Jan;44(1):22-33
pubmed: 23893158
World J Gastroenterol. 2013 Sep 7;19(33):5565-74
pubmed: 24023502
Am J Surg. 2014 Jan;207(1):127-38
pubmed: 24124659
Gastrointest Endosc. 2014 Jun;79(6):970-82.e7; quiz 983.e2, 983.e5
pubmed: 24650852
Gastrointest Endosc. 2014 Nov;80(5):747-61.e1-75
pubmed: 25436393
Can J Surg. 2015 Jun;58(3):167-71
pubmed: 25799132
World J Gastrointest Endosc. 2016 Feb 25;8(4):198-204
pubmed: 26962401
Expert Rev Gastroenterol Hepatol. 2017 Jul;11(7):633-641
pubmed: 28325090
GE Port J Gastroenterol. 2017 May;24(3):122-128
pubmed: 28848796
CA Cancer J Clin. 2018 Jan;68(1):7-30
pubmed: 29313949
Endosc Int Open. 2018 May;6(5):E558-E567
pubmed: 29756013
Dig Endosc. 2019 Jan;31(1):51-58
pubmed: 30113095
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593