Safety and efficacy of metallic stents in the management of colorectal obstruction.
BACKGROUND
The use of self-expandable metallic stents in the management of obstructing colorectal cancer has been described with increasing frequency in the literature. Our goal was to evaluate the efficacy and associated morbidity of the use of self-expandable metallic stents to relieve colorectal obstruction at our institution.


METHODS
A retrospective chart review of patients who underwent colorectal stent placement between December 2001 and December 2003 in a tertiary referral center was performed.


RESULTS
Stents were placed successfully in 17 of 21 patients (81%) with colorectal obstruction. Placement was achieved endoscopically in 13 patients and radiologically in 4. Ten self-expandable metallic stents were used as a bridge to surgery, and 7 were used for palliation. The obstructions were located in the sigmoid colon (11 patients), the rectosigmoid (3), the splenic flexure, the hepatic flexure, and the rectum. Malignant obstruction was noted in 14 patients. One patient with malignancy experienced a sigmoid perforation, and 2 patients with benign disease had complications (1 stent migration and 1 re-obstruction). Stent patency in obstruction secondary to colonic adenocarcinoma was 100% in our follow-up period (range, 5 to 15 months).


CONCLUSIONS
The use of stents as a bridge to surgery is associated with low morbidity, allows for bowel preparation, and thus avoids the need for a temporary colostomy. Long-term patency suggests that stents may allow for the avoidance of an operation in patients with metastatic disease and further defines their role in the palliation of malignant obstruction. Further prospective randomized studies are necessary to fully elucidate the use of stents in the management of colorectal cancer.
Stefanidis
Dimitrios
D
Department of Surgery, Division of Surgical Oncology, University of Texas Health Science Center, San Antonio 78229-3900, USA.
Brown
Ken
K
Nazario
Hector
H
Trevino
Hector H
HH
Ferral
Hector
H
Brady
Charles E
CE
Gross
Glenn W
GW
Postoak
Darren W
DW
Chadhury
Riaz
R
Rousseau
Dennis L
DL
Kahlenberg
Morton S
MS
D000230:Adenocarcinoma / Q000150:complications*; D000368:Aged; D003110:Colonic Neoplasms / Q000150:complications*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents
D008670:Metals