Colonic Decompression as Alternative to Diverting Colostomy ›

Colonic Decompression as Alternative to Diverting Colostomy ›
tech ni que sp o t l i g h t
WallFlex™ Colonic Stent
Colonic Decompression as an
Alternative to Diverting Colostomy
Sean E. McGarr, DO
Kennebec Gastrointestinal Associates
Maine General Medical Center, Augusta, Maine
Director of Gastrointestinal Oncology,
Harold Alfond Center for Cancer Care
Cancer Physician Liaison for the Commission on Cancer
Patient History
A 69-year-old male presented in the ED with acute bowel obstruction. A colonoscopy was performed and it
was determined the obstruction was caused by a malignant neoplasm of the colon. The patient had a surgical
consult and had a choice of a two stage Hartmann procedure or a colonic stent placement to decompress
the bowel followed by colonic resection. It was decided to proceed with the colonic stent placement in order
to reduce the number of surgeries as well as to speed up the time when the resection could take place.
Figure 1
A frond-like, villous, fungating, infiltrative completely obstructing large mass was found in the recto-sigmoid
colon. The mass was circumferential and measured 10cm in length. The mass was traversed using a .035
Dreamwire™ Guidewire under fluoroscopic guidance. A 22mm x 120mm WallFlex Colonic Stent was
passed through the scope and traversed the stricture. The stent was deployed under both fluoroscopic and
endoscopic guidance. (Figure 1) The stent was carried to the rectal vault to avoid the anus. Immediate
relief of obstruction was noted. (Figure 2)
Post Procedure
Figure 2
During the procedure, immediate decompression was seen as the stent was deployed. (Figure 3) The
patient did very well post procedure and was discharged the same day (inpatient). After further testing, it was
determined that the patient had metastatic cancer and therefore was not a candidate for surgical intervention.
If the patient is an appropriate candidate for stenting, I always give them that option and tend to encourage
that over the diverting colostomy as a preparation for colonic resection. The advantages to the patient are
that they have one surgical procedure instead of two and the decompression time may be more comfortable
or at least less invasive by passing stool normally instead of into a colostomy bag. Additionally, the percentage
of patients who choose not to have the colostomy reversed or are no longer surgical candidates is not
insignificant, therefore it makes sense to go with the option your patient would be most comfortable with
in the event it becomes a long term fix rather than a preparation for surgical intervention.
Figure 3
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Ordering Information
Results from case studies are not predictive of results in other cases. Results in other cases may vary.
WallFlex and Dreamwire are registered trademarks of Boston Scientific Corporation or its affiliates.
Indications, Contraindications, Warnings and Instructions for Use can be found in the product labeling supplied with each device.
CAUTION: Federal (USA) law restricts this device to sale by or on the order of a physician.
©2013 Boston Scientific Corporation
or its affiliates. All rights reserved.
ENDO-168904-AA 1M July 2013
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