Berg, E.H. van den (2013) Position and functioning of the colon stent. thesis, Medicine.
Full text available on request.Abstract
Introduction: Endoscopic self-expanding metal stent (SEMS) placement is widely applied for the management of acute colonic obstruction for patients with a colorectal carcinoma. SEMS placement can serve as a definitive palliative treatment in incurable or inoperable patients or as a bridge to surgery in a curative setting and improve the condition of the patient for elective surgery, avoiding an emergency operation. There are no data concerning the influence of radiological SEMS location. Methods: Patients, in whom first SEMS had been inserted as bridge to surgery or as a palliative measure between July 2003 and August 2012, with an acute colorectal obstruction were retrospectively analyzed (n = 137). We investigated the associations between the asymmetry and angulation of the stent, the number of stents, minimal and maximal lumen and mimimal/maximal lumen ratio of the stent, the visible immediate endoscopic relief of feces during stent deployment, the production of feces after 24 hours and the need of urgent surgery within three weeks after the procedure. Results: Although a more symmetrically placed SEMS was positively associated with direct endoscopic relief and a straight position of the stent was associated with better functioning after 24 hours, neither asymmetry, angulation or small post-deployment lumen directly after deployment were associated with the risk of non-elective surgery within three weeks, as was the length of the SEMS. However patients with two SEMS, either for elongation or because the first one had been malpositioned had an increased risk of non-elective surgery (p = 0.03). The only other variables that were associated with non-elective surgery within three weeks were poor resolution of ileus after 24 hours, a SEMS placed for palliative intent, a benign cause of obstruction and a cecal diameter on CT of more than 10 cm at presentation. In a multivariate analysis it was demonstrated that palliative intent (p = 0.003), an insufficient resolution of ileus after 24 hours (p = 0.001), and placement of two SEMS (p = 0.01) were independent predictors for non-elective surgery. Conclusion: The asymmetry, position and angulation of a stent in a malignant colonic stenosis is not of influence on the risk of non-elective surgery. Patients with double stents and without sufficient defecation after 24 hours are at risk for non-elective surgery for treatment of the ileus.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Borg Dr. F. ter MD PhD, Gastroenterologist Deventer Ziekenhu and Department: Gastro-Enterology, Deventer Hospital |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:03 |
| Last Modified: | 25 Jun 2020 11:03 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2273 |
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