Malignant rectal obstruction within 5 cm of the anal verge: is there a role for expandable metallic stent placement?
BACKGROUND
Placement of expandable metallic stents (EMS) has been considered contraindicated for patients with malignant rectal obstruction within 5 cm of the anal verge because of the potential problems of anal pain.


OBJECTIVE
Our purpose was to investigate the technical feasibility, clinical effectiveness, and safety of EMS placement in patients with malignant rectal obstruction within 5 cm of the anal verge.


METHODS
Retrospective study.


METHODS
Single tertiary referral university hospital.


METHODS
The sites of obstruction included the rectum within 5 cm (range, 25-50 mm) of the anal verge in 16 patients (group A) and more than 5 cm (range, 53-74 mm) in 14 patients (group B).


METHODS
Placement of 3 types of EMS.


METHODS
Complications including pain were evaluated and compared between 2 groups with the Fisher exact test.


RESULTS
The overall technical success rate was 100%. Colon perforation occurred in 2 patients, who underwent emergency surgery. Ten (62.5%) of group A and 1 (7.1%) of group B complained of pain (P = .011). In 3 of the 10 patients in group A, the pain disappeared spontaneously within a week or was tolerated by the patients without use of analgesics, although the remaining 7 patients of group A and the 1 patient in group B needed analgesics until death or elective surgery.


CONCLUSIONS
Retrospective study.


CONCLUSIONS
Placement of EMS in patients with malignant rectal obstruction within 5 cm of the anal verge seems feasible and relatively safe and may provide adequate palliation and preoperative decompression of obstruction symptoms. Anal pain was tolerable to the patients with or without use of analgesics.
Department of Radiology, Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ho-Young
HY
Song
Jin Hyoung
JH
Kim
Kyung Rae
KR
Kim
Ji Hoon
JH
Shin
Hee Cheol
HC
Kim
Chang-Sik
CS
Yu
Jin Cheon
JC
Kim
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000628:therapy*; D007416:Intestinal Perforation / Q000209:etiology; D008297:Male; D008670:Metals; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010166:Palliative Care; D011140:Polyurethanes; D012002:Rectal Diseases / Q000628:therapy*; D012004:Rectal Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
D008670:Metals; D011140:Polyurethanes