title: Self-expanding metal stents in malignant colonic obstruction: experiences from Sweden.
abstract: BACKGROUND
  Acute surgery in the management of malignant colonic obstruction is associated with high morbidity and mortality. The use of self-expanding metal stents (SEMS) is an alternative method of decompressing colonic obstruction. SEMS may allow time to optimize the patient and to perform preoperative staging, converting acute surgery into elective. SEMS is also proposed as palliative treatment in patients with contraindications to open surgery.
  
  
  OBJECTIVE
  To review our experience of SEMS focusing on clinical outcome and complications. The method used was a review of 75 consecutive trials at SEMS on 71 patients based on stent-protocols and patient charts.
  
  
  RESULTS
  SEMS was used for palliation in 64 (85%) cases and as a bridge to surgery in 11 (15%) cases. The majority of obstructions, 53 (71%) cases, were located in the recto-sigmoid. Technical success was achieved in 65 (87%) cases and clinical decompression was achieved in 60 (80%) cases. Reasons for technical failure were inability to cannulate the stricture in 5 (7%) cases and suboptimal SEMS placement in 3 (4%) cases. Complications included 4 (5%) procedure-related bowel perforations of which 2 (3%) patients died in junction to post operative complications. Three cases of bleeding after SEMS occurred, none of which needed invasive treatment. Five of the SEMS occluded. Two cases of stent erosion were diagnosed at the time of surgery. Average survival after palliative SEMS treatment was 6 months.
  
  
  CONCLUSIONS
  Our results correspond well to previously published data and we conclude that SEMS is a relatively safe and effective method of treating malignant colonic obstruction although the risk of SEMS-related perforations has to be taken into account.
authors.affiliation: Department of Surgery, Skane University Hospital Malmö, Lund University, S-20502 Malmö, Sweden. Mattias.lepsenyi@med.lu.se.
authors.forename: Mattias
authors.initials: M
authors.lastname: Lepsenyi
authors.forename: Stefan
authors.initials: S
authors.lastname: Santen
authors.forename: Ingvar
authors.initials: I
authors.lastname: Syk
authors.forename: Jörgen
authors.initials: J
authors.lastname: Nielsen
authors.forename: Artur
authors.initials: A
authors.lastname: Nemeth
authors.forename: Ervin
authors.initials: E
authors.lastname: Toth
authors.forename: Henrik
authors.initials: H
authors.lastname: Thorlacius