Biomedical subjects
M R Yates
Publications and source records attributed to M R Yates.
Treatment of a radiation-induced sigmoid stricture with an expandable metal stent.
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Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes.
BACKGROUND: Acute left-sided colonic obstruction is a surgical emergency whose management is controversial. Because experience using expandable metal stents for relief of this type of obstruction is limited, we evaluated their effectiveness, feasibility, safety, and outcome. METHODS: Twenty-five patients with acute colorectal obstruction underwent placement of various metal stents under fluoroscopic and endoscopic guidance. On an intent-to-treat basis, stents were placed for decompression before one-stage surgical resection in 10 patients and palliatively in 15 patients. Two preoperative patients had unresectable malignant disease, and stents were left for palliation resulting in 17 palliative and 10 preoperative patients for analysis. RESULTS: Stent placement was technically successful in 94% of patients. Overall effectiveness in relieving obstruction was 85% (palliative 82%, preoperative 90%). In the palliative group, stent duration ranged from 2 to 64 weeks (mean 17.3 weeks). Major complications occurred in 7 patients (30%). CONCLUSIONS: Expandable metal stents are a feasible, effective adjunct and alternative to surgery for acute colorectal obstruction.
Palliation of malignant gastric and small intestinal strictures with self-expandable metal stents.
BACKGROUND: Malignant gastrointestinal obstruction is a common preterminal event that is often treated surgically. The use of self-expandable stents to treat malignant gastric and small intestinal strictures is limited. We evaluated the feasibility, effectiveness, safety and outcome of self-expandable metal stents in providing palliative care for patients with inoperable malignant strictures of the stomach and small intestine. METHODS: Eleven consecutive patients with complete or near complete gastric or small intestinal obstruction were treated palliatively with self-expandable metal stents. Contrast radiographs were taken before and after insertion in all patients to confirm patency. Nineteen stents were placed using biliary guidewires and catheters under endoscopic and fluoroscopic guidance. Diets were modified as needed. Success was defined both technically and clinically. RESULTS: Technical and clinical success with improvement in the patient's oral diet was achieved in ten patients (91%). The one failure was caused by severe anastomotic angulation and distal luminal obstruction. During the follow-up of 5 to 294 days (mean 77 days) there were no major complications except that the stents occluded in four patients. CONCLUSION: Palliation of malignant gastric and small intestinal strictures with self-expandable metal stents is a feasible, effective, and safe alternative to operation.