Management of acute malignant colorectal obstruction with a novel self-expanding metallic stent as a bridge to surgery.
OBJECTIVE
To prospectively evaluate the safety and clinical efficacy of a newly designed self-expandable metallic stent (SEMS) in the treatment of patients with acute malignant colorectal obstruction.


METHODS
Between April 2001 and October 2007, 52 patients with acute malignant colorectal obstruction were treated with a new designed SEMS as an investigational bridge to surgery. Patients were prospectively followed and relevant data collection was collected, including details regarding technique, clinical symptoms, complications, need for elective surgery, and overall survival.


RESULTS
Stent placement was technically successful in all but two patients (due to complete obstruction) with no procedure-related complications. Complications included stent migration (n=4), anal pain (n=2) and stool impaction (n=1). Clinical success was achieved in 49 (98%) of 50 patients with resolution of bowel obstruction within 2 days of stent placement. In one patient with stool impaction 2 days after stent placement, endoscopic disimpaction was successfully performed. An elective one-stage surgical procedure was performed in all 50 patients who successfully received a SEMS as a bridge to surgery within a mean of 8+/-2 days (range: 4-11 days) after stent placement. Mean follow-up time was 36+/-12 months (range 3-70 months), and all patients remained alive at the time of this report.


CONCLUSIONS
The newly designed SEMS placement as a bridge to surgery was a safe and effective intervention for colonic decompression in patients with acute malignant colorectal obstruction and allowed a high proportion of patients to be successfully proceeded to elective surgery.
Li
Yong-Dong
YD
Department of Radiology and Research Institute of Radiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China.
Cheng
Ying-Sheng
YS
Li
Ming-Hua
MH
Fan
You-Ben
YB
Chen
Ni-Wei
NW
Wang
Yu
Y
Zhao
Jun-Gong
JG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications* / Q000601:surgery*; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects; D015996:Survival Rate; D016896:Treatment Outcome
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide