Self expanding wall stents in malignant colorectal cancer: is  complete obstruction a contraindication to stent placement?
OBJECTIVE
Technical failures have previously been associated with complete clinical obstruction and complete block to the retrograde flow of gastrograffin is considered by some to be a contraindication to the procedure. We report on the technical and clinical success rates of self-expanding metallic stents (SEMS) in both complete and incomplete obstruction in a prospective series of malignant colorectal obstructions.


METHODS
A prospective study of all patients undergoing attempted palliative and bridge to surgery SEMS placement for malignant colorectal obstruction over a 7-year period (April 1999-October 2006) was undertaken.


RESULTS
Seventy-two patients (49 males) with a mean age of 71 years (range 49-98) were included. Technical success was achieved in 27 of 32 patients (84%) with complete obstruction and 33 of 36 patients (92%) with incomplete obstruction, P < 0.46, Fishers exact test. Clinical success was achieved in 17 of 26 patients (65%) with complete obstruction and 24 of 33 patients (73%) with incomplete obstruction, P < 0.58, Fishers exact test. Although placed correctly in 89% cases, relief of symptoms occurred in only 71%, P = 0.002, matched pairs test. There were two colonic perforations in the series with one procedure related death.


CONCLUSIONS
Placement of SEMS for obstructing colorectal cancer is technically successful in a high proportion of cases. Complete radiological obstruction is not a contraindication to stent placement. The relief of obstructive symptoms following successful placement of a wall stent is less predictable.
Stenhouse
G J A
GJ
Lanarkshire Colorectal Study Group, Monklands General Hospital, Airdrie, UK.
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Rowan
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Giles
L
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Macdonald
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D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000150:complications* / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000150:complications*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D015607:Stents