3469 An international multicenter colorectal stent registry: work in progress.

Abstract

Colonic stents are gaining interest globally. Indications & results are not clear, since experience at single centers is relatively small. Hence 5 international centers have established a registry of patients undergoing colorectal stenting, to evaluate their performance. We report the preliminary results of 47 attempts in 38 patients (17 males) (mean age 65 yr., range 33- 92) enrolled so far. Indications included bridge to surgery (7); palliation for unresectable cancer (31); undecided long term plan (9). At presentation 12 had complete colonic obstruction; 26 had partial obstruction of which 10 had intermittent & 16 persistent symptoms. The etiology of the obstruction was malignant in 34 cases, benign in 7 & unclear in 6 cases at the time of stenting. Site of obstruction was rectosigmoid in 41 & more proximal in 6. Stenting failed in 9 cases (guidewire could not be passed in 4; length of the stent was insufficient in 2; other technical reasons in 3). 4 pts. underwent stenting twice (1 for migration; 3 for reobstruction), whereas 1 pt. underwent stenting 5 times for recurrent migration. Types of stents used were: Wallstent (18), Choo stent (11), Ultraflex (10), Instent Esophacoil (2), other (3). 32 were uncovered. Pretreatment practices varied with 2 cases undergoing Argon plasma coagulation; 4 balloon dilation & 7 Savary dilation. Decompression was achieved in 86% (37 cases). 42% encountered early complications (bleeding 2, reobstruction 3, perforation 2, migration 5, other 2) while delayed migration was seen in 5 cases & delayed obstruction was seen in only 3 cases. Complication rate in the pretreated gp (3/13) was not higher compared to the non-pretreated gp (19/25). Complications were treated as follows: endoscopic snaring of granulation tissue (1); repeat stenting (5-migration; 3- reobstruction); surgery (1-reobstruction); balloon dilation (1-incomplete stent expansion). In 4 pts. with stent migration, another stent was deemed not necessary. 13 (31%) patients underwent surgery of which 12 were done within 42 days of stent placement. Prestenting surgical plan in these was bridge to surgery (5); palliation (4); surgery undecided (4). The stent proved to be a useful palliative measure in the remaining 29 (69%) patients. Based on these interim results it appears that colon stents are relatively easy to insert & can be effective as a bridge to surgery in resectable cancer patients, & for palliation in the unresectable cases. The registry will now be expanded to answer more specific questions, & more centers will be invited to participate.