Experience with endoluminal colonic wall stents for the management of large bowel obstruction for benign and malignant disease.
OBJECTIVE
To assess the applicability and efficacy of endoluminal colonic wall stents (ECWSs) in the management of large bowel obstruction (LBO).


METHODS
Inception cohort study.


METHODS
University-based tertiary medical center.


METHODS
Eleven consecutive patients with LBO in the absence of peritonitis.


METHODS
Placement of ECWS under endoscopic and fluoroscopic guidance.


METHODS
The success rate in ECWS placement, the efficacy in decompressing the obstruction, and the patency rate of the ECWS.


RESULTS
Successful placement of ECWSs was obtainable in 10 of 11 patients. Once placed, all 10 patients achieved immediate decompression of their LBO. Eight patients had malignant obstructions associated with distant spread of disease; 3 patients had diverticular disease. Among those with malignant obstruction, 6 patients had successful and lasting palliation without colostomy, 1 patient underwent 1-stage resection 1 month later with no evidence of obstruction, and 1 patient could not be stented so diversion was done. None of the patients with diverticular disease required diversion: 2 had complete bowel preparation followed by resection with primary anastomosis, whereas the third declined surgery. Four of the 10 patients required overlapping ECWSs to bridge the stricture. One patient required a second ECWS secondary to recurrence of obstruction after stent migration and has continued palliation of his stage 4 rectal cancer for the last 11 months. No other complications were encountered.


CONCLUSIONS
Urgent surgery with colostomy for LBO was avoided in 10 of 11 patients because of successful placement of ECWSs. We believe that endoscopic colonic stenting is safe, effective, and lasting, and should be considered as initial nonoperative management in all patients seen with LBO in the absence of peritonitis.
Tamim
W Z
WZ
Department of Surgery, University of Massachusetts Medical School, Worcester, USA.
Ghellai
A
A
Counihan
T C
TC
Swanson
R S
RS
Colby
J M
JM
Sweeney
W B
WB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000150:complications*; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome