title: Low morbidity and mortality after stenting for malignant bowel obstruction.
abstract: BACKGROUND
  The difference in mortality between emergency and elective surgery for malignant colonic obstruction is more than 5% in healthy patients below the age of 65 and increases with age to around 20%. Emergency surgery can be avoided by endoscopic placement of a self-expandable metal stent (SEMS).
  
  
  OBJECTIVE
  To evaluate the effectiveness and safety of SEMS as 'bridge to surgery'.
  
  
  METHODS
  Between January 2001 and July 2008, SEMS were placed for acute malignant colonic obstruction in 45 patients (median age 72 years, range 35-91).
  
  
  RESULTS
  The procedure was technically successful in 43 patients (94%) with resolution of obstructive symptoms within 48 h in 87% of the patients. No perforations occurred during the procedure or while awaiting surgery. Two (4%) patients required a second endoscopic procedure. All patients underwent a single-stage surgical procedure. Postoperative mortality was 2.2% (n = 1). Histology showed advanced colorectal cancer (T3-4N1-2M0-1) in 75% of the patients.
  
  
  CONCLUSIONS
  SEMS placement is a safe and effective procedure as bridge to surgery in patients presenting with colonic obstruction due to colorectal malignancy. This procedure carries a risk of serious complications well below that of the reported difference in mortality between emergency an elective surgery.
authors: Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands. jjdriest@gmail.com
authors: J J
authors: JJ
authors: Driest
authors: H H
authors: HH
authors: Zwaving
authors: M
authors: M
authors: Ledeboer
authors: M
authors: M
authors: Eeftinck Schattenkerk
authors: E J
authors: EJ
authors: Kuipers
authors: F
authors: F
authors: Ter Borg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D004630:Emergencies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D015607:Stents / Q000009:adverse effects