WallFlex colonic stent placement for management of malignant colonic obstruction: a prospective study at two centers.
BACKGROUND
Self-expanding metal stents (SEMSs) can alleviate malignant colonic obstruction and avoid emergency decompressive surgery. The use of colonic larger-diameter SEMSs may improve bowel function and reduce migration risk.


OBJECTIVE
To evaluate the effectiveness and safety of a novel large-diameter SEMS (WallFlex) designed for delivery through the endoscope in treating malignant colonic obstruction.


METHODS
Prospective clinical cohort study.


METHODS
Two Italian study centers.


METHODS
Forty-two consecutive patients with malignant colonic obstruction: 23 requiring palliation and 19 bridging to surgery.


METHODS
Colorectal SEMS placement.


METHODS
Technical success, defined as accurate SEMS deployment across the stricture on the first attempt; clinical success, ie, complete relief of bowel obstruction without complications; and bridging to surgery, denoting the performance of elective one-stage surgery.


RESULTS
The rate of technical success was 93% (95% CI, 81%-99%) and of initial clinical success was 95% (95% CI, 84%-99%). In 58% (95% CI, 40%-84%) of the palliation group, clinical success was maintained after 6 months. All 19 patients with operable tumors were successfully bridged to one-stage elective surgery within a median of 5 days. One perforation and one stent migration occurred. All complications could be resolved nonsurgically.


CONCLUSIONS
No control group was included.


CONCLUSIONS
In a prospective study of through-the-scope WallFlex stent placement for malignant colonic obstruction, high rates of technical and initial clinical success, and bridging to surgery were achieved. Complications could be readily managed.
D000230:Adenocarcinoma / Q000150:complications; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D012809:Colon, Sigmoid / Q000473:pathology; D003110:Colonic Neoplasms / Q000150:complications; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D012810:Sigmoid Diseases / Q000209:etiology / Q000628:therapy*; D015607:Stents
D000497:Alloys; C013616:nitinol