Fluoroscopically guided placement of self-expandable metallic stents and stent-grafts in the treatment of acute malignant colorectal obstruction.
OBJECTIVE
To evaluate the technical feasibility and clinical effectiveness of fluoroscopically guided placement of self-expandable metallic stents and stent-grafts for acute malignant colorectal obstruction.


METHODS
Radiologic images and clinical reports of 42 patients (22 men, 20 women; age range, 28-93 years; median age, 65.5 years) who underwent fluoroscopically guided colorectal stent insertion without endoscopic assistance for acute malignant obstruction were reviewed retrospectively. Eighteen patients received bare stents as a bridge to surgery. Twenty-four patients received 27 insertions of either a bare stent (n = 15) or a stent-graft (n = 12) for palliation. The obstruction was located in the rectum (n = 8), sigmoid (n = 17), descending colon (n = 8), splenic flexure (n = 3), and transverse colon (n = 6).


RESULTS
Clinical success, defined as more than 50% dilatation of the stent with subsequent symptomatic improvement, was achieved in 41 of the 42 patients (98%). No major procedure-related complications occurred. Minor complications occurred in eight of the 45 procedures (18%). No perioperative mortalities occurred within 1 month after surgery. In the palliative group, the median stent patency was 62 days (range, 0-1,014 days). There was no statistically significant difference in stent patency between the bare stents (range, 0-855 days; median, 68 days) and stent-grafts (range, 1-1,014 days; median, 81 days).


CONCLUSIONS
Fluoroscopically guided placement of self-expandable metallic stents and stent-grafts for the relief of acute malignant colorectal obstruction was technically feasible without endoscopic assistance-even in lesions proximal to the splenic flexure and transverse colon-and clinically effective in both bridge to surgery and palliative management.
Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Republic of Korea.
Honsoul
H
Kim
Seung Hyoung
SH
Kim
Sun Young
SY
Choi
Kwang-Hun
KH
Lee
Jong Yoon
JY
Won
Do Yun
DY
Lee
Jong Tae
JT
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D003108:Colonic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000150:complications*; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D011474:Prosthesis Design; D015641:Radiography, Interventional; D012002:Rectal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
D008670:Metals