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Tertiary stent-in-stent for obstructing colorectal cancer: A case report and literature review
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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354113/ https://www.ncbi.nlm.nih.gov/pubmed/30705733 http://dx.doi.org/10.4253/wjge.v11.i1.61 |
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author | Vanella, Giuseppe Coluccio, Chiara Di Giulio, Emilio Assisi, Daniela Lapenta, Rocco |
author_facet | Vanella, Giuseppe Coluccio, Chiara Di Giulio, Emilio Assisi, Daniela Lapenta, Rocco |
author_sort | Vanella, Giuseppe |
collection | PubMed |
description | 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: 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: Tertiary SEMS-in-SEMS is technically feasible, and appears to be a safe and effective option in the case of recurrent SEMS obstruction. |
format | Online Article Text |
id | pubmed-6354113 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-63541132019-01-31 Tertiary stent-in-stent for obstructing colorectal cancer: A case report and literature review Vanella, Giuseppe Coluccio, Chiara Di Giulio, Emilio Assisi, Daniela Lapenta, Rocco World J Gastrointest Endosc Case Report 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: 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: Tertiary SEMS-in-SEMS is technically feasible, and appears to be a safe and effective option in the case of recurrent SEMS obstruction. Baishideng Publishing Group Inc 2019-01-16 2019-01-16 /pmc/articles/PMC6354113/ /pubmed/30705733 http://dx.doi.org/10.4253/wjge.v11.i1.61 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Case Report Vanella, Giuseppe Coluccio, Chiara Di Giulio, Emilio Assisi, Daniela Lapenta, Rocco Tertiary stent-in-stent for obstructing colorectal cancer: A case report and literature review |
title | Tertiary stent-in-stent for obstructing colorectal cancer: A case report and literature review |
title_full | Tertiary stent-in-stent for obstructing colorectal cancer: A case report and literature review |
title_fullStr | Tertiary stent-in-stent for obstructing colorectal cancer: A case report and literature review |
title_full_unstemmed | Tertiary stent-in-stent for obstructing colorectal cancer: A case report and literature review |
title_short | Tertiary stent-in-stent for obstructing colorectal cancer: A case report and literature review |
title_sort | tertiary stent-in-stent for obstructing colorectal cancer: a case report and literature review |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354113/ https://www.ncbi.nlm.nih.gov/pubmed/30705733 http://dx.doi.org/10.4253/wjge.v11.i1.61 |
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