Endoscopy 2007; 39(5): 448-454
DOI: 10.1055/s-2007-966270
Original article

© Georg Thieme Verlag KG Stuttgart · New York

A dual-design expandable colorectal stent for malignant colorectal obstruction: results of a multicenter study

H.-Y.  Song1 , J.  H.  Kim1 , J.  H.  Shin1 , H.-C.  Kim2 , C. S.  Yu2 , J.-C.  Kim2 , S.-G.  Kang3 , C.  J.  Yoon3 , J.  Y.  Lee4 , J. H.  Koo5 , K.-H.  Lee6 , J.-K.  Kim7 , D.  H.  Kim8 , T.-B.  Shin9 , G.-S.  Jung10 , Y.-M.  Han11
  • 1Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  • 2Department of General Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  • 3Department of Radiology, Bundang Hospital, Seoul National University 300, Gumidong, Gyeonggi-do, Republic of Korea
  • 4Department of Radiology, Seoul National University Hospital 28, Seoul, Republic of Korea
  • 5Department of Radiology, Seoul Adventist Hospital 29-1, Seoul, Republic of Korea
  • 6Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Republic of Korea
  • 7Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Dongju, Gwangju, Republic of Korea
  • 8Department of Radiology, Chosun University College of Medicine, Dong-gu, Gwangju, Republic of Korea
  • 9Department of Radiology, Dong-A Medical Center, University of Dong-A College of Medicine, Dongdaesin-Dong, Seo-Gu, Busan, Republic of Korea
  • 10Department of Radiology, Dankook University hospital, Anseo-Dong, Cheonan, Chungcheong Nam Do, Republic of Korea
  • 11Department of Radiology, Chonbuk National University Medical School, Keumam Dong, Jeonju, Jeonbuk, Republic of Korea
Further Information

Publication History

submitted 4 July 2006

accepted after revision 10 November 2006

Publication Date:
22 May 2007 (online)

Background and study aims: It is known that metal stent placement is safe, easy, and effective for the treatment of malignant colorectal obstruction, but these stents are associated with delayed complications of tumor ingrowth and stent migration. The aim of this study was to prospectively investigate the technical feasibility, clinical effectiveness, and safety of a dual-design colorectal stent (consisting of an outer stent and an inner bare nitinol stent) in patients with malignant colorectal obstruction.

Patients and methods: Placement of the dual stent using a 4.5-mm stent delivery system was attempted in 151 patients with malignant colorectal obstruction, either before surgery (n = 50) or for palliation (n = 101). Multivariate logistic regression analysis was used to identify risk factors associated with complications.

Results: Stent placement was technically successful in 145/151 patients (96 %). Of the patients who had a technically successful placement, bowel obstruction resolved within 2 days after stent placement in 48/50 (96 %) of the patients in the bridge-to-surgery group and in 87/95 (92 %) of the patients in the palliative group. Perforation occurred in 16 patients, incomplete stent expansion in eight patients, stent migration in four patients, tumor overgrowth in five patients, severe rectal pain in five patients, and bleeding in eight patients. Complete obstruction was the only significant risk factor for perforation (odds ratio 6.88, 95 % CI 2.04 - 23.17, P = 0.002). In the palliative group, the median survival was 152.0 days and the mean survival was 263.8 days.

Conclusions: The dual stent with a 4.5-mm stent delivery system is easy to insert, safe, and reasonably effective for the palliative treatment of malignant colorectal obstruction. However, a great deal of care is needed in its deployment because of the high rate of perforation.


  • 1 Deans G T, Krukowski Z H, Irwin S T. Malignant obstructions of the left colon.  Br J Surg. 1944;  81 1270-1276
  • 2 Griffith R S. Preoperative evaluation: medical obstacles to surgery.  Cancer. 1992;  70 1333-1341
  • 3 Leitman I M, Sullivan J D, Brams D. et al . Multivariate analysis of the morbidity and mortality from initial surgical management of obstructing carcinoma of the colon.  Surg Gynaecol Obstet. 1992;  174 513-518
  • 4 Mulcahy H E, Skelly M M, Hussain A. et al . Long-term outcome following curative surgery for malignant large bowel obstruction.  Br J Surg. 1996;  83 707-710
  • 5 Wong R, Rappaport W, Witze D. et al . Factors influencing the safety of colostomy closure in the elderly.  J Surg Res. 1994;  57 289-292
  • 6 Camunez F, Echenagusia A, Simo G. et al . Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation.  Radiology. 2000;  216 492-497
  • 7 Meisner S, Hensler M, Knop F K. et al . Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center.  Dis Colon Rectum. 2004;  47 444-450
  • 8 Canon C L, Baron T H, Morgan D E. et al . Treatment of colonic obstruction with expandable metal stents: radiologic features.  AJR Am J Roentgenol. 1997;  168 199-205
  • 9 De Gregorio M A, Mainar A, Tejero E. et al . Acute colorectal obstruction: stent placement for palliative treatment - results of a multicenter study.  Radiology. 1998;  209 117-120
  • 10 Law W L, Chu K W, Ho J WC. et al . Self-expanding metallic stent in the treatment of colonic obstruction caused by advanced malignancies.  Dis Colon Rectum. 2000;  43 1522-1527
  • 11 Baron T H. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract.  N Engl J Med. 2001;  344 1681-1687
  • 12 Choo I W, Do Y S, Suh S W. et al . Malignant colorectal obstruction: treatment with a flexible covered stent.  Radiology. 1998;  206 415-421
  • 13 Khot U P, Lang A W, Murali K, Parker M C. Systematic review of the efficacy and safety of colorectal stents.  Br J Surg. 2002;  89 1096-1102
  • 14 Sebastian S, Johnston S, Geoghegan T. et al . Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction.  Am J Gastroenterol. 2004;  99 2051-2057
  • 15 Song H Y, Shin J H, Lim J O. et al . Use of a newly designed multifunctional coil catheter for stent placement in the upper gastrointestinal tract.  J Vasc Interv Radiol. 2004;  15 369-373
  • 16 Jung G S, Song H Y, Kang S G. et al . Malignant gastroduodenal obstructions: treatment by means of a covered expandable metallic stent - initial experience.  Radiology. 2000;  216 758-763
  • 17 Grunshaw N D, Ball C S. Palliative treatment of an enterorectal fistula with a covered metallic stent.  Cardiovasc Intervent Radiol. 2001;  24 438-440
  • 18 Kang S G, Jung G S, Cho S G. et al . The efficacy of metallic stent placement in the treatment of colorectal obstruction.  Korean J Radiol. 2002;  3 79-86

H.-Y. Song, MD

Department of Radiology

Asan Medical Center

University of Ulsan College of Medicine

388-1 Poongnap-2dong


Seoul 138 - 736

Republic of Korea

Fax: +82-2-476-0090

Email: hysong@amc.seoul.kr