Expandable metal stents for treatment of colonic obstruction

Academic Article

Abstract

  • INTRO: Colonic obstruction carries a high morbidity and mortality, and usually requires a colostomy. We evaluated the feasibility of expandable metal stents to avoid colostomy. METHODS: 15 consecutive pts. with complete or near-complete colonic obstruction were treated with expandable metal stents for palliation (N=10) and pre-operatively to avoid colostomy (N=5). Success was defined as ability to defecate or to adequately prep the colon for one-stage operation. RESULTS: Mean age 62 yrs. (Range. 46-89 yrs.). Ω=complete obstruction.*=Adjuvant local XRT. Tumor/Site Stent mm Intent Outcome Duration Status Comp. Rectum 1 Ultraflex 18 Palliate Success 22 wks. Dead-patent None Rectum Ultraflex 18 Palliate Success 26 wks. Alive-patent*None Rectum Ultraflex 18 Palliate Success 36 wks. Alive-patent*Migration Siqmoid 1 Wallstent 10 Palliate Success 8 wks. Dead-patent Perf. Rectum Ultraflex18 Palliate Success 24 wks. Dead-patent None Rectum 1 Ecoil/Ultraflex18 Palliate Success 2 wks. Dead-patent None Proximal descending 1 Wallstent 22 Wallstent 20 Palliate Success 17 wks. Alive Overgrowth re-stented Rectosig. Ultraflex 18 Palliate Failure N/A Alive- surgery Perf.-surgery Rectosig. 1 Wallstent 16 Palliate Failure 4wks. Dead None Rectosig. Wallstent 22 Palliate Failure N/A Dead Perf.- surgery Rectum 1 Ultraflex18 Pre-op Success 10 days Alive None Transverse 1 Wallstent 10 Pre-op Success 6 days Alive None Rectosig.- benign Wallstent 22 Pre-op Success 3 wks. Alive Migration Transverse 1 Wallstent 10 Pre-op Failure 4 days Alive. Migration Transverse 1 Wallstent 10 Pre-op Failure 3 days Dead- surgery Migration Overall success=67%:palliation 7/10;pre-op 3/5.Complications: 1 each of self-limited perforation, bacteremia; 4-migration; 2-major perforation (both dilated). Procedure-related mortality 1/15 (7%). Overgrowth in 1-successfully restented. CONCLUSIONS: 1) Successful colonic stenting is feasible using available endoprostheses 2) Changes in stent design are needed to prevent migration 3) Dilatation should be avoided during stent placement as perforation may result 4) Colonic stenting appears to be a viable alternative to surgery for palliation of malignant colorectal neoplasms given the availability and potential cost-effectiveness.
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    Author List

  • Baron TH; Dean PA; Shumate CR; Koehler RE; Canon C
  • Start Page

  • 363
  • Volume

  • 43
  • Issue

  • 4