[Self-expandable metallic stent for palliative treatment of colorectal malignant obstructions: risk of perforation].
OBJECTIVE
The self-expandable metallic stents are a good alternative to surgery for the palliative treatment of malignant colonic obstructions. The aim of this paper was to emphasize the causes which could increase the risk of perforation.


METHODS
From November 2000 to November 2001, 6 patients with malignant colonic obstruction, to whom surgery was denied due to tumor extension and/or poor general condition, have had a palliative treatment (N = 5) or an attempt (N = 1) with self-expandable metallic stents placed by endoscopy.


RESULTS
Only one patient did not developed any complication and died 5 months later of cancer. Five out of the 6 patients (83%) developed a colonic perforation following stenting (N = 4) or the attempt to place the stent (N = 1), two into the first 24 h after the procedure, and three 3, 5, and 10 months later. Subsequent colostomy was done in 2 patients while the 3 others have had an external drainage of the perforation and died postoperatively.


CONCLUSIONS
The self-expandable metallic stents seems to be a less aggressive alternative therapy to surgery for malignant colonic obstructions. Nevertheless, the high rate of colonic perforations, suggests reconsidering the indications in the definitive palliation of malignant colonic obstructions.
Scurtu
R
R
Service de chirurgie générale et digestive, CHU Tenon, 4, rue de la Chine, 75970 Paris 20, France.
Barrier
A
A
André
T
T
Houry
S
S
Huguier
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000209:etiology* / Q000517:prevention & control*; D015179:Colorectal Neoplasms / Q000150:complications*; D003125:Colostomy; D004724:Endoscopy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000517:prevention & control*; D007416:Intestinal Perforation; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D015607:Stents; D016896:Treatment Outcome