Colon Stenting: A Review

Abstract

Up to 85% of patients who present with colonic obstruction have a colorectal cancer. Between 7% and 29% of these patients present with total or partial intestinal obstruction. Only 20% of these patients presenting with acute colonic obstruction due to malignancy survive 5 years. Emergent surgical intervention in patients with colonic obstruction is associated with significant morbidity and mortality rates. Only 40% of patients with obstructive carcinoma of the left colon can be treated with surgical resection without the need for a colostomy. The use of a temporary or permanent colostomy has a significant impact on quality of life. The decompressive effect seen with colonic stenting is a durable, simple, and effective palliative treatment of patients with advanced disease. Stent deployment provides an effective solution to acute colonic obstruction and allows surgical treatment of the patient in an elective and more favorable condition. In addition, colonic stenting reduces costs and avoids the need for a colostomy.

Complementary roles of interventional radiology and therapeutic endoscopy in gastroenterology

“…Similar to upper GI strictures, fluoroscopic guided balloon dilatation and/or stent placement has also been described for the lower GI tract for patients as a pre-surgical or palliative relief[111,112]. Typically, the procedure involves placing the patient supine on the fluoroscopy table.…”

“…Appropriate stents should cover the lesion with 1-2 cm extension beyond the obstruction. Covered stents are not recommended due to risk of migration[111]. Water-soluble contrasted enema can be repeated immediately or any time after the procedure to evaluate placement.…”

Enteral stents: Complications and their management

“…Minor complications related to colon stent placement such as mild to moderate rectal bleeding, transient anorectal pain, temporary incontinence, and fecal impaction are common in many reports (Table 1). [16][17][18][19][20][21][22][23][24][25][26] Late complications related to SEMS mainly include re-obstruction and migration of the stent, and rarely perforation. Migration incidence varies from 4% to 26% and is one of the more frequent complications observed at early follow-up.…”

“…Migration incidence varies from 4% to 26% and is one of the more frequent complications observed at early follow-up. [20][21][22][23][24][25][26] Obstruction can recur as a result of fecal impaction or tumor ingrowth. 21 Growth of the tumor through the mesh is the main disadvantage of uncovered stents, and its incidence varies from 2% to 20%.…”

“…The drawstring of the systems allows collapsing the distal end of the stent to facilitate retrieval. 23 The drawstring can be grabbed with a special hook under fluoroscopic guidance or with a forceps under endoscopic guidance. In some cases the drawstring is broken or embedded in the mucosa and may not be reachable, stent retrieval can be performed using the eversion technique where the more distal end of the stent is grabbed with the hook and the stent is everted and retrieved.…”