A retrospective analysis of palliative colonic stent placement in an elderly population

Abstract

Self-expanding metal stents (SEMS) have added a new dimension to the management of colonic malignant obstruction. We present our experience of palliative colonic stent insertion in a group of patients unsuitable for surgery. Since 1995 11 patients (median age 82 years) with strictures of the rectosigmoid region underwent SEMS placement at this Hospital. The indications for stent placement were large bowel obstruction (n=6), overflow incontinence (n=4) and faecal fistula (n=1). The selection criteria included five patients with disseminated disease and six who were deemed unfit for surgery. SEMS insertion was performed under fluoroscopic control in all patients, and colonoscopic assistance was required in four patients where fluoroscopy alone failed. SEMS placement was successful in nine patients with resulting bowel decompression and immediate symptomatic relief, but failed in two patients. Where SEMS placement was unsuccessful, the stricture was impassable in one instance and in the other the patient withdrew consent. Stent migration occurred in three out of nine patients. The median survival time after stent placement was 5 months; one patient is still alive at 14 months. SEMS placement resulted in the successful palliation of symptoms in patients with obstructive lesions deemed unfit for surgery-however, it is not always successful and there are complications.