ABSTRACT
Interventional radiologists are often called on to help with quality of life issues
in end-stage cancer patients. Many times, the discomfort can be directly associated
to the tumor mass itself, but in other instances, tumors can cause secondary obstruction
of normal structures that can lead to patient distress. As with most palliative care
patients, their medical conditions are not conducive to major surgery; therefore minimally
invasive techniques are ideal for the treatment of these conditions. The following
discussion addresses the various nonvascular interventions available to these patients,
including the indications and limitations of these procedures.
KEYWORDS
Biliary obstruction - hydronephrosis/hydroureter - gastric outlet obstruction
REFERENCES
- 1
McDougall E M, Bennett H F, Monk T G et al..
Functional MR imaging of the porcine kidney: physiologic changes of prolonged pneumoperitoneum.
JSLS.
1997;
1
29-35
- 2
Ballinger A B, McHugh M, Catnach S M et al..
Symptom relief and quality of life after stenting for malignant bile duct obstruction.
Gut.
1994;
35
467-470
- 3
Razavi R, Hill D L, Keevil S F et al..
Cardiac catheterisation guided by MRI in children and adults with congenital heart
disease.
Lancet.
2003;
362
1877-1882
- 4
Zhai R, Qian X, Dai D et al..
Malignant biliary obstruction: treatment with interventional radiology.
Chin Med J (Engl).
2003;
116
888-892
- 5
Brountzos E N, Ptochis N, Panagiotou I et al..
A survival analysis of patients with malignant biliary strictures treated by percutaneous
metallic stenting.
Cardiovasc Intervent Radiol.
2007;
30
66-73
- 6
Nakamura T, Hirai R, Kitagawa M et al..
Treatment of common bile duct obstruction by pancreatic cancer using various stents:
single-center experience.
Cardiovasc Intervent Radiol.
2002;
25
373-380
- 7
Prat F, Chapat O, Ducot B et al..
Predictive factors for survival of patients with inoperable malignant distal biliary
strictures: a practical management guideline.
Gut.
1998;
42
76-80
- 8
Park do H, Kim M H, Choi J S et al..
Covered versus uncovered Wallstent for malignant extrahepatic biliary obstruction:
a cohort comparative analysis.
Clin Gastroenterol Hepatol.
2006;
4
790-796
- 9
Soderlund C, Linder S.
Covered metal versus plastic stents for malignant common bile duct stenosis: a prospective,
randomized, controlled trial.
Gastrointest Endosc.
2006;
63
986-995
- 10
Yoon W J, Lee J K, Lee K H et al..
A comparison of covered and uncovered Wallstents for the management of distal malignant
biliary obstruction.
Gastrointest Endosc.
2006;
63
996-1000
- 11
Baijal S S, Dhiman R K, Gupta S et al..
Percutaneous transhepatic biliary drainage in the management of obstructive jaundice.
Trop Gastroenterol.
1997;
18
167-171
- 12
Born P, Rosch T, Triptrap A et al..
Long-term results of percutaneous transhepatic biliary drainage for benign and malignant
bile duct strictures.
Scand J Gastroenterol.
1998;
33
544-549
- 13
Cozzi G, Gavazzi C, Civelli E et al..
Percutaneous gastrostomy in oncologic patients: analysis of results and expansion
of the indications.
Abdom Imaging.
2000;
25
239-242
- 14
Buckley D L, Drew P J, Mussurakis S et al..
Microvessel density of invasive breast cancer assessed by dynamic Gd-DTPA enhanced
MRI.
J Magn Reson Imaging.
1997;
7
461-464
- 15
Smith J W, Brennan M F.
Surgical treatment of gastric cancer: proximal, mid, and distal stomach.
Surg Clin North Am.
1992;
72
381-399
- 16
Lorentzen T, Nolsoe C P, Adamsen S.
Percutaneous radiologic gastrostomy with a simplified gastropexy technique under ultrasonographic
and fluoroscopic guidance: experience in 154 patients.
Acta Radiol.
2007;
48
13-19
- 17
de Baere T, Zhang X, Aubert B et al..
Quantification of tumor uptake of iodized oils and emulsions of iodized oils: experimental
study.
Radiology.
1996;
201
731-735
- 18
Nassif T, Prat F, Meduri B et al..
Endoscopic palliation of malignant gastric outlet obstruction using self-expandable
metallic stents: results of a multicenter study.
Endoscopy.
2003;
35
483-489
- 19
Mosler P, Mergener K D, Brandabur J J et al..
Palliation of gastric outlet obstruction and proximal small bowel obstruction with
self-expandable metal stents: a single center series.
J Clin Gastroenterol.
2005;
39
124-128
- 20
Adler D G, Baron T H.
Endoscopic palliation of malignant gastric outlet obstruction using self-expanding
metal stents: experience in 36 patients.
Am J Gastroenterol.
2002;
97
72-78
- 21
Kim T O, Kang D H, Kim G H et al..
Self-expandable metallic stents for palliation of patients with malignant gastric
outlet obstruction caused by stomach cancer.
World J Gastroenterol.
2007;
13
916-920
- 22
Lindsay J O, Andreyev H J, Vlavianos P et al..
Self-expanding metal stents for the palliation of malignant gastroduodenal obstruction
in patients unsuitable for surgical bypass.
Aliment Pharmacol Ther.
2004;
19
901-905
- 23
Lopera J E, Brazzini A, Gonzales A et al..
Gastroduodenal stent placement: current status.
Radiographics.
2004;
24
1561-1573
- 24
Bessoud B, de Baere T, Denys A et al..
Malignant gastroduodenal obstruction: palliation with self-expanding metallic stents.
J Vasc Interv Radiol.
2005;
16
247-253
- 25
Kaw M, Singh S, Gagneja H, Azad P.
Role of self-expandable metal stents in the palliation of malignant duodenal obstruction.
Surg Endosc.
2003;
17
646-650
- 26
Yoon C J, Song H Y, Shin J H et al..
Malignant duodenal obstructions: palliative treatment using self-expandable nitinol
stents.
J Vasc Interv Radiol.
2006;
17
319-326
- 27
Jeong J Y, Kim Y J, Han J K et al..
Palliation of anastomotic obstructions in recurrent gastric carcinoma with the use
of covered metallic stents: clinical results in 25 patients.
Surgery.
2004;
135
171-177
- 28
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
- 29
Mauro M A, Koehler R E, Baron T H.
Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal
obstructions with metallic stents.
Radiology.
2000;
215
659-669
- 30
Jung G S, Song H Y, Seo T S et al..
Malignant gastric outlet obstructions: treatment by means of coaxial placement of
uncovered and covered expandable nitinol stents.
J Vasc Interv Radiol.
2002;
13
275-283
- 31
Song T J, Ip E W, Fong Y.
Hepatocellular carcinoma: current surgical management.
Gastroenterology.
2004;
127(suppl 1)
S248-S260
- 32
Law W L, Choi H K, Chu K W.
Comparison of stenting with emergency surgery as palliative treatment for obstructing
primary left-sided colorectal cancer.
Br J Surg.
2003;
90
1429-1433
- 33
Buechter K J, Boustany C, Caillouette R, Cohn I.
Surgical management of the acutely obstructed colon: a review of 127 cases.
Am J Surg.
1988;
156
163-168
- 34
Martinez-Santos C, Lobato R F, Fradejas J M et al..
Self-expandable stent before elective surgery vs. emergency surgery for the treatment
of malignant colorectal obstructions: comparison of primary anastomosis and morbidity
rates.
Dis Colon Rectum.
2002;
45
401-406
- 35
Repici A, Pagano N, Hervoso C M et al..
Metal stents for malignant colorectal obstruction.
Minim Invasive Ther Allied Technol.
2006;
15
331-338
- 36
Law W L, Choi H K, Lee Y M, Chu K W.
Palliation for advanced malignant colorectal obstruction by self-expanding metallic
stents: prospective evaluation of outcomes.
Dis Colon Rectum.
2004;
47
39-43
- 37
Maetani I, Tada T, Ukita T et al..
Self-expandable metallic stent placement as palliative treatment of obstructed colorectal
carcinoma.
J Gastroenterol.
2004;
39
334-338
- 38
Aviv R I, Shyamalan G, Watkinson A et al..
Radiological palliation of malignant colonic obstruction.
Clin Radiol.
2002;
57
347-351
- 39
Repici A, Reggio D, De Angelis C et al..
Covered metal stents for management of inoperable malignant colorectal strictures.
Gastrointest Endosc.
2000;
52
735-740
- 40
Zollikofer C L, Jost R, Schoch E, Decurtins M.
Gastrointestinal stenting.
Eur Radiol.
2000;
10
329-341
- 41
Radecka E, Magnusson M, Magnusson A.
Survival time and period of catheterization in patients treated with percutaneous
nephrostomy for urinary obstruction due to malignancy.
Acta Radiol.
2006;
47
328-331
- 42
Wilson J R, Urwin G H, Stower M J.
The role of percutaneous nephrostomy in malignant ureteric obstruction.
Ann R Coll Surg Engl.
2005;
87
21-24
- 43
Ganatra A M, Loughlin K R.
The management of malignant ureteral obstruction treated with ureteral stents.
J Urol.
2005;
174
2125-2128
- 44
Joshi H B, Adams S, Obadeyi O O, Rao N.
Nephrostomy tube or “JJ” ureteric stent in ureteric obstruction: assessment of patient
perspectives using quality-of-life survey and utility analysis.
Eur Urol.
2001;
39
695-701
- 45
Ku J H, Lee S W, Jeon H G et al..
Percutaneous nephrostomy versus indwelling ureteral stents in the management of extrinsic
ureteral obstruction in advanced malignancies: are there differences?.
Urology.
2004;
64
895-899
- 46
Pandian S S, Hussey J K, McClinton S.
Metallic ureteric stents: early experience.
Br J Urol.
1998;
82
791-797
- 47
Wakui M, Takeuchi S, Isioka J et al..
Metallic stents for malignant and benign ureteric obstruction.
BJU Int.
2000;
85
227-232
- 48
Tekin M I, Aytekin C, Aygun C et al..
Covered metallic ureteral stent in the management of malignant ureteral obstruction:
preliminary results.
Urology.
2001;
58
919-923
Kent T SatoM.D.
Assistant Professor, Department of Radiology, Northwestern University Medical School
251 E Huron Street, Room 4-710R Feinberg, Chicago, IL 60611
Email: k-sato@northwestern.edu