Self-expanding Metal Stents in the Context of Colonic Obstruction: A Retrospective Analysis From 45 Cases.

Hector Marin, Mikel Prieto, Laura Buendia, Alberto Lamiquiz, Aingeru Sarriugarte, Jose Maria Garcia, Andoni Larzabal, Tamara Moreno, Alberto Colina. Cruces University Hospital

OBJECTIVES Colonic stents have been increasingly used as a non-surgical choice to relieve colonic obstruction, most frequently in cases of advanced colorectal cancer. This approach could provide the opportunity of performing a one-stage elective procedure with primary anastomosis, instead of an emergent operation with the necessity of a diverting colostomy. Our objective was to assess the results of colonic stent placement for benign and malignant disease in our center.
METHODS Forty five cases of colonic stent placement carried out in our center from January 2010 to April 2011 where analyzed. These included 42 cases of advanced colorectal cancer, and 3 cases of obstruction due to benign conditions (one postsurgical anastomosis stricture and two extrinsic compressions from endometriosis and ovarian cancer).
RESULTS Technical success rate of the procedure was very high (97, 8%), with only one case of impossibility to place the stent. Clinical success defined as obtainment of an effective long-term palliative decompression or until an elective procedure was carried out was obtained in 29 cases (64, 4%). In other 3 cases (6, 7%) decompression was finally achieved after the placement of another stent, and other 2 cases (4, 4%) finally needed a diverting colostomy. The objective of stent placement for temporal decompression as a bridge to surgery was established for 11 patients, and in 9 of them (81, 8%) this objective was achieved. Perforation occurred in 7 cases (15, 5%), with delayed perforation being the most common (6 out of 7 cases), mainly in the site of the stent placement, but in 2 cases it was located in proximal colonic segments. Stent migration, which required repetition of the procedure, was described in 3 patients (6, 7%). Minor complications, such as occasional bleeding or abdominal pain were not considered.
CONCLUSION The use of stents for managing colonic obstruction is feasible and effective, despite potential complications, allowing the practice of one-stage procedures and reduced morbidity in many cases, and providing effective palliation in others.
 

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