[Treatment of colorectal obstruction with self-expanding metal stents].
BACKGROUND
Self-expanding metal stents (SEMS) serve as a bridge to surgery in cases of acute colorectal obstruction and provide palliation without surgery in patients with severe co-morbidity or disseminated disease. We describe our experiences with the use of SEMS in colorectal obstruction.


METHODS
We analysed a consecutive series of 162 SEMS procedures in 141 patients (72 men (51%)) in the period between May 1997 and September 2004. The median age of the patients was 75 years (range 28-101). In 11 patients the stricture was caused by benign pathology. The indication of the procedure was in 62 (44%) of the cases in patients with cancer acute obstruction.


RESULTS
Seventeen patients needed more than one SEMS procedure. Perforation of the colon by the stent was seen in 2% of the cases, and the frequency of stent migration was 10%. The 30-day mortality rate after SEMS procedure and subsequent resection was 17% in cases of malign acute obstruction. Resection without stoma was achieved in 76% of the cases. Fifteen patients with acute obstruction received SEMS as the definitive treatment. In the group of patients who received SEMS as palliation, only 10% needed a stoma in the follow-up period. In 11 cases of benign strictures, only 4 were successful.


CONCLUSIONS
SEMS is a safe, effective procedure in the treatment of colorectal obstruction. It reduces the mortality and morbidity rates, as well as the need for stomas. In our experience, stenting of benign strictures is ineffective and associated with higher rates of complications.
Bertelsen
Claus Anders
CA
H:S Bispebjerg Hospital, Kirurgisk Afdeling K. anders.bertelsen@dadlnet.dk
Meisner
Søren
S
West
Finn
F
Wille-Jørgensen
Peer A
PA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011379:Prognosis; D019919:Prosthesis Implantation; D011859:Radiography; D012002:Rectal Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome