The role of colonic stents in extracolonic malignant large-bowel obstruction

Abstract

To the Editor: Recently, Faraz et al 1 reported that multifocal diseases and peritoneal carcinomatosis were risk factors in the technical and clinical success of stent placement in extracolonic malignant large-bowel obstruction. We would like to raise several concerns about the role of colonic stents in relieving intestinal obstruction. First, stent placement is difficult in cases with extrinsic compression, according to our experience. Stents may easily migrate as a result of intestinal peristalsis. There was only 1 case of stent migration in that study. We ask whether the authors could share more details about stent selection and placement technique. Second, it would be helpful to know the patients' clinical features, including obstruction type, tumor stage, tumor location, and stricture length, along with the technical features of the stent, including length, diameter, type and numbers. 2-4 Lee et al 2 reported that covered stents and full obstruction could negatively affect the clinical outcomes of stent treatment for malignant rectal obstruction. Previous studies suggested that 25 mm was the optimal stent diameter for colonic obstruction. 5,6 Third, small-bowel obstruction also occurs from extracolonic malignancies, accounting for 44% to 52%, 7 but that was not mentioned in this study. For stage 1 or 2 extracolonic malignancies, surgery might be a better choice. Some published studies have reported that stent placement was not always effective for colonic obstruction resulting from extracolonic malignancies. 8,9 As shown, the median survival was only 3.3 months. Were there any therapeutic applications after stent placement? As a palliative approach, was stent placement the better choice for these patients? For patients with extracolonic malignancy, stent indications and outcomes should be further determined. DISCLOSURE All authors disclosed no financial relationships relevant to this publication.