Preliminan Study About Three-lumen Balloon Catheter In The Treatment Of Self-expandable Metal Stent Placement For Obstructive Colorectal Cancer

Background:Self-expanding metal stent placement has been widely used in malignant colorectal obstruction in recent years.It can be used to serve as either bridge to surgery in resectable cases or final treatments in palliative cases.The conventional technique of stent placement was using standard catheter to pass the guidewire through stenosis site first.Guidewire was then removed and contrast was injected through the catheter to estimate the stenosis length.Besides,it had technical difficulties especially in sharply angulated lesions in the proximal intestinal cavity of stenosis.In this study,three-lumen balloon catheter assisted guidewire was used to confirm whether it was in the intestinal lumen by retaining the guidewire,and the narrow segment was measured by balloon.This study was conducted to explore the role and safety of three-lumen balloon catheter in the implantation of stents in malignant colorectal obstruction.Methods:40 patients with obstructive colorectal cancer who underwent stent placement at the First Affiliated Hospital of Soochow University from March 2017 to December 2019 were enrolled in the study.With the three-lumen balloon catheter assistance,the guidewire was placed into the dilated intestinal cavity,and the contrast was injected with the guidewire retained.The distribution of the contrast could be observed under the X-ray to ensure that the guidewire was located in the intestinal cavity.When the dilated intestinal cavity was obvious angulated,the guidewire could not enter the deep part of cavity.In this study,the balloon was dilated by gas,and the intestinal cavity was straightened in the process of pulling back,so that the guidewire could enter the deep part of the proximal intestinal cavity.When the balloon was pulled back to the ostium side of the stenosis,the contrast medium was injected into the balloon cavity.The length of the stenosis could be accurately measured in the distance between the balloon position and the end of the lens.Appropriate length of the stent was selected accordingly,and the stent was inserted through the guidewire.During the operation,patients were observed for complications such as major bleeding and perforation.The technical success rate,clinical success rate and the incidence of early complications were observed.Results:40 patients with malignant colorectal obstruction underwent stent implantation,including 24 males and 16 females,aged from 44 to 95 years.The sites of obstruction included 12 cases in rectum(30.0%),13 cases in sigmoid colon(32.5%),6 cases in descending colon(15.0%),3 cases in splenic flexure(7.5%),1 case in transverse colon(2.5%),1 case in hepatic flexure(2.5%),2 cases in ascending colon(5.0%)and 2 cases in ileocecum(5.0%).37 cases were successfully implanted with self-expanding metal stent,and no adverse operation events such as massive bleeding and perforation occurred during the operation.Among the 37 cases,2 cases had clinical failure after stent implantation.According to preoperative CT,2 cases misjudged that the obstructive site was located in the ascending colon,but in fact,it was located in the ileocecum.In 1 case,the stent was placed successfully,but the clinical symptom was not relieved obviously,and the middle segment of the stent was located in the ileocecal valve surrounded by the mass.Another case was transferred to surgery because there was no enough space for guidewire exploration during stent implantation,which showed that the ileocecal space was limited and the clinical remission effect was not good,so it was not suitable for stent placement and the case was removed from 40 cases and was not counted in the observation index.The technical success rate of stent implantation was 94.9%(37/39),and the clinical success rate was 94.6%(35/37).Minor early complications occurred in 16.2%,including 3 cases of slight bleeding and 3 cases of acute severe sensation.Major early complications occurred in 2.7%,including 1 case of perforation after stent implantation 104 hours later.Conclusions:With the assistance of three-lumen balloon catheter,insertion of guidewire especially in sharply angulated lesions can be easier.In the process,the guidewire can be retained instead of exchanging guidewire and catheter,and the length of the stenosis can be accurately measured by imaging balloon.It can be seen that this method has the advantages of simple operation,accurate measurement under X-ray,safety,having high success rate of implantation.It is worth popularizing application in clinic.