Palliative stenting of malignant large bowel obstruction

Abstract

OBJECTIVE: Untreated malignant large bowel obstruction is rapidly fatal. Short-term palliation of symptoms can be achieved by formation of a stoma in those patients for whom resection surgery is inappropriate. In the final months of life, a stoma represents a significant burden for both patients and carers. Palliative endoluminal stenting may therefore be an attractive alternative option for this poor prognosis group. In this paper, we examine our experience of palliative endoluminal colonic stenting. PATIENTS: Twenty patients, 11 males and 9 females of median age 81 years were referred for stenting. All had left sided colonic cancers. Ten patients had confirmed metastases on presentation, four had fixed rectal cancers and the remainder had severe comorbidity limiting surgical options. Stents were placed endoscopically using a radiologically controlled 'stent over wire' technique. RESULTS: Stenting successfully relieved the obstruction in 18 of the 20 patients attempted. In one patient the stricture could not be negotiated and the procedure was abandoned. Eleven patients have died of their disease, their median duration of palliation was 50 days (3-152 days). The rest of the patients continue in follow-up and have had 80 days median palliation (14-257 days). One stent-related complication has been observed in a patient who suffered anal pain due to fracture and migration of part of a stent into the low rectum. This complication occurred after 250 days and the distal stent fragment was removed with further symptom relief. CONCLUSION: Carefully selected patients benefit from colonic endoluminal stenting with relief of obstructive symptoms. They may be spared the potential problems associated with palliative stoma formation.

Factors associated with the long-term outcome of a self-expandable colon stent used for palliation of malignant colorectal obstruction

“…In addition, most patients in the reports had undergone SEMS implantation before a definitive surgical treatment (''bridge to surgery'' concept) for acute colorectal obstruction [7], or the studies included mixed groups of patients. These prior studies provide information that has only limited relevance for the longterm effects of SEMS implantation as a definitive palliative treatment for bowel obstruction in patients with colorectal carcinoma [9,10,17]. This has resulted in only a few available reports on the long-term problems associated with SEMS implantation with palliative intent for malignant colorectal obstruction and the durability of the procedure according to the stent type, method of stent placement, and location of the tumor.…”

“…The colon obstruction was located fluoroscopically using a water-soluble contrast medium. Next, the stricture was passed with a guidewire, over which the stent was inserted into the obstruction and released under fluoroscopic guidance [12,17].…”

Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis

“…Metallic endoprostheses can also provide palliative relief of colonic strictures in patients with unresectable tumors, while obviating the performance of a risky surgical procedure without demonstrated benefits [6,11,18,30,[33][34][35]. For these patients, stenting is considered to be the palliative treatment of choice [23].…”

“…However, high rates of safety and effectiveness have been reported in two studies (85% and 90%, respectively) [15,20]. Although it is not a new technique, stenting has rarely been performed as a palliative perhaps measures, because of its relatively high cost [33,36].…”

Intestinal Obstruction and Perforation – The Role of the Gastroenterologist

“…Early complications after the procedure are stent migration, bowel perforation and bleeding [25]. Late complications are similar and stent migration is the most frequent.…”