Complications of colonic stenting: a pictorial review

Abstract

Surgical resection of colorectal carcinoma is the only curative treatment currently available. In the elective setting peri-operative mortality is low and refinements in surgical technique and peri-operative care have resulted in high primary anastamosis rates and progressively reduced postoperative morbidity. In those presenting with large bowel obstruction the mortality and morbidity remains high. Many of those undergoing surgery will have incurable disease and a short life expectancy. Increasingly self-expanding metal stents are being deployed as either a 'bridge to surgery' or for palliation. This review covers the imaging appearances, detection and management of complications of colonic stenting.

Gastrointestinal stenting: Current status and imaging features

“…Tumor overgrowth is the most common cause (Fig. 6), ingrowth through the stent lattice, mucosal prolapse, stent fracture and fecal impaction are less frequent [98,126,131]. In case of stent obstruction due to cancer progression, laser/argon therapy, stent in stent, or surgery can be done [79,127].…”

“…In a systematic review, Khot et al have reported 3 deaths in a total of 565 colonic stent placements; two of them were due to colonic perforation [126]. Colonic perforation is predominantly observed in patients who had balloon dilation of the colonic stenosis or incomplete initial stent deployment [126,130,131]. Risk factors for early perforation following stent insertion are stenosis dilation prior to stent insertion, try to pass the stenosis with the endoscope or excessive manipulation of guide wires, especially in the presence of diverticular disease or early wall ischemia [131].…”

“…Colonic perforation is predominantly observed in patients who had balloon dilation of the colonic stenosis or incomplete initial stent deployment [126,130,131]. Risk factors for early perforation following stent insertion are stenosis dilation prior to stent insertion, try to pass the stenosis with the endoscope or excessive manipulation of guide wires, especially in the presence of diverticular disease or early wall ischemia [131]. Type and size of the stent have to fit stenosis and colonic features in order to avoid stent incarceration.…”

Management of Recurrent Large Bowel Obstruction Due to Stent Occlusion by ‘Stent-Over-Stent’: A Case Report and Literature Review

“…c perforation, stent migration, stent occlusion, and bleeding have been reported [1, 10,17]. In particular, stent occlusion is seen in around 10-16% of patients and occurs more frequently in palliative settings [1,6,14,20].…”

“…Additionally, it allows these patients to enjoy the full benefits of minimally invasive surgery [16]. It is a safe procedure with low mortality rates of approximately 1% [1,17]. Various reviews have reported technical and clinical success rates of 75% -100% and 84% -100% respectively [1, 10,18,19].…”