Large-diameter self-expanding metal stents appear to be safe and effective for malignant colonic obstruction with and without concurrent use of chemotherapy.
BACKGROUND
Colonic stents are used chiefly for malignant large-bowel obstruction as a palliative measure or bridge to surgery that facilitates one-step resections. Literature on colorectal stenting demonstrates good safety and efficacy; however, a recent trial has raised concerns regarding the safety of a new large-diameter stent, especially in the setting of concurrent chemotherapy. This study evaluated our experience with colorectal stenting using mainly this stent.


METHODS
The study was a retrospective chart review with a minimum 6-month telephone follow-up of patients who underwent colorectal stenting for malignant obstruction at Queen's University between December 2005 and March 2008. The primary outcome was clinical success, defined as full or partial relief of obstructive symptoms or successful bridge to surgery. Clinical failure was defined as persistence or recurrence of obstructive symptoms, death from obstruction, or the need for unplanned surgical intervention.


RESULTS
Thirty patients underwent stenting for malignant obstruction during the study period. The technical success rate was 96.7%. Clinical success was 83% at 30 days and 69% at 6 months. The complication rate was 20%, with four early and two late complications. There were no perforations or stent migrations. Thirty-three percent of patients received chemotherapy with a stent in situ; this was not associated with an increased complication rate. Ninety-one percent of patients and families reported satisfaction with the procedure.


CONCLUSIONS
Large-diameter stents appear to be safe for malignant colonic obstruction with and without concurrent chemotherapy and they have similar complication rates as older-generation stents with perhaps lower migration potential.
Bielawska
Barbara
B
Division of Gastroenterology, Department of Medicine, Gastrointestinal Diseases Research Unit, Queen's University, Hotel Dieu Hospital, Kingston, ON, K7L 3N6, Canada. 6bb13@queensu.ca
Hookey
Lawrence C
LC
Jalink
Diederick
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002404:Catheterization / Q000009:adverse effects; D003108:Colonic Diseases / Q000209:etiology / Q000628:therapy*; D003110:Colonic Neoplasms / Q000150:complications* / Q000188:drug therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D007416:Intestinal Perforation / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D015607:Stents / Q000009:adverse effects
D000970:Antineoplastic Agents