title: Ten-year retrospective study of treatment of malignant colonic obstructions with self-expandable stents.
abstract: OBJECTIVE
  To describe the use of self-expandable metallic stents to manage malignant colorectal obstructions and to compare the radiation dose between fluoroscopic guidance of stent placement and combined endoscopic and fluoroscopic guidance.
  
  
  METHODS
  From January 1998 to December 2007, 467 oncology patients undergoing colorectal stent placement in a single center were included in the study. Informed consent was obtained in all cases. All procedures were performed with fluoroscopic or combined fluoroscopic and endoscopic guidance. Inclusion criteria were total or partial colorectal obstruction of neoplastic origin. Exclusion criteria were life expectancy shorter than 1 month, suspicion of perforation, and/or severe colonic neoplastic bleeding. Procedure time and radiation dose were recorded, and technical and clinical success were evaluated. Follow-up was performed by clinical examination and simple abdominal radiographs at 1 day and at 1, 3, 6, and 12 months.
  
  
  RESULTS
  Of 467 procedures, technical success was achieved in 432 (92.5%). Thirty-five treatments (7.5%) were technical failures, and the patients were advised to undergo surgery. Significant differences in radiation dose and clinical success were found between the fluoroscopy and combined-technique groups (P < .001). Total decompression was achieved in 372 cases, 29 patients showed remarkable improvement, 11 showed slight improvement, and 20 showed clinical failure. Complications were recorded in 89 patients (19%); the most significant were perforation (2.3%) and stent migration (6.9%). Mean interventional time and radiation dose were 67 minutes and 3,378 dGy·cm(2), respectively.
  
  
  CONCLUSIONS
  Treatment of colonic obstruction with stents requires a long time in the interventional room and considerable radiation dose. Nevertheless, the clinical benefits and improvement in quality of life justify the radiation risk.
authors.affiliation: Research Group in Minimally Invasive Techniques, University of Zaragoza, Avda Miguel Servet 177, Zaragoza 50013, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: de Gregorio
authors.forename: Alicia
authors.initials: A
authors.lastname: Laborda
authors.forename: Eloy
authors.initials: E
authors.lastname: Tejero
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miguelena
authors.forename: Francisco C
authors.initials: FC
authors.lastname: Carnevale
authors.forename: Ignacio
authors.initials: I
authors.lastname: de Blas
authors.forename: Mariano
authors.initials: M
authors.lastname: Gimenez
authors.forename: Manuel
authors.initials: M
authors.lastname: Maynar
authors.forename: Horacio
authors.initials: H
authors.lastname: D'Agostino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003108:Colonic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D011474:Prosthesis Design; D011829:Radiation Dosage; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013030:Spain; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D008670:Metals