Management of colon stents based on Bernoulli's principle.

BACKGROUND AND AIMS

The colonic self-expanding metal stent (SEMS) has been widely used for "bridge to surgery" and palliative therapy. However, if the spread of SEMS is insufficient, not only can a decompression effect not be obtained but also perforation and obstructive colitis can occur. The mechanism of occurrence of obstructive colitis and perforation was investigated by flow dynamics.

METHODS

Bernoulli's principle was applied, assuming that the cause of inflammation and perforation represented the pressure difference in the proximal lumen and stent. The variables considered were proximal lumen diameter, stent lumen diameter, flow rate into the proximal lumen, and fluid density. To model the right colon, the proximal lumen diameter was set at 50 mm. To model the left-side colon, the proximal lumen diameter was set at 30 mm.

RESULTS

For both the right colon model and the left-side colon model, the difference in pressure between the proximal lumen and the stent was less than 20 mmHg, when the diameter of the stent lumen was 14 mm or more. Both the right colon model and the left-side colon model were 30 mmHg or more at 200 mL s when the stent lumen was 10 mm or less. Even with an inflow rate of 90-110 mL s, the pressure was 140 mmHg when the stent lumen diameter was 5 mm.

CONCLUSION

In theory, in order to maintain the effectiveness of SEMS, it is necessary to keep the diameter of the stent lumen at 14 mm or more.