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.
Baron
T H
TH
Department of Medicine, University of Alabama at Birmingham Medical Center, 35294-0007, USA.
Dean
P A
PA
Yates
M R
MR
Canon
C
C
Koehler
R E
RE
D000208:Acute Disease; D003108:Colonic Diseases / Q000209:etiology / Q000628:therapy*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications; D004638:Emergency Treatment; D016099:Endoscopy, Gastrointestinal; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011300:Preoperative Care; D012002:Rectal Diseases / Q000209:etiology / Q000628:therapy*; D015607:Stents; D016896:Treatment Outcome