Colorectal obstruction: treatment with metallic stents.

Abstract

Metallic stent placement to relieve acute colonic obstruction secondary to colorectal carcinoma is a safe therapeutic alternative, allowing single-stage surgery in suitable cases. In patients who are not surgical candidates it is an adequate palliative option.

Use of self-expanding metallic stents in the management of obstruction of the sigmoid colon.

“…Al though the presentsystemmakesit possibleto stent growths in the proximal colon, most pa tients who would benefit from stenting have distal colonic obstruction. In previous studies [5,7] of patients with resectablecancer, stent migration caused re current obstruction and incomplete bowel cleansing; however, in our study, the stent mi grated in only one patient, but obstruction did not recur in that patient. Our greater success could be due to the larger diameter of the en teral Wallstent (22 mm) compared with those designedfor esophagealuse (14â€"1 8 mm).…”

“…In our study, one patient developed intestinal obstructionwhile awaiting electivesurgeryof a resectabletumor.The resultsofother studies [5,7] and our study suggest that elective colonic resectionshould be planned as early as possi ble, preferably within 7â€"14 days of successful stenting. Elective colonic resection would de crease the number of patients readmitted with recurrent obstruction due to stent migration, co lonic blockage,or diseaseprogression.…”

“…However, somepatients in this group may not be palliated by the procedure becauseof the advancednatureof their disease,asshown in a previous report [7]. These patients may have many sitesof partial obstruction so that if stent patencyis confirmed, they are unlikely to ben efit from a colostomy.…”

“…Esophageal stents have a smaller diameter of 10â€"20 mm and are less flexible. These limitations may ex plain the greater incidence of stent migration and blockage in previous studies [2,5,7]. Pre dilatation of the stricture or laser therapy [2] may also prevent the stricture from gripping the stent,resulting in stentmigration.…”

Complications and Lessons Learned from 10 Years of Expandable Gastrointestinal Prostheses

“…Acutely angulated malignancies are probably best treated with vival (3-4 months), regardless of the stent type [13]. 30. Although all stents were placed successfully, remanipul-whereas stent dysfunction (57 vs. 32%) and need for reintervention (90 vs. 34%) were higher.…”