Clinical experience with colonic stent placement

Abstract

Fluoroscopic-guided colonic stent placement has grown in acceptance in treating both benign and malignant acute colonic occlusions for both palliative and surgical decompression purposes. Seventeen patients underwent self-expandable metallic colonic stent placement. Thirteen patients had acute obstruction requiring surgical decompression. The remaining four patients had stent placement for palliative purposes. Stents were deployed using the standard Tejero-Mainar technique of crossing the lesion with a torquable guidewire and catheter, replacing the wire for a stiff wire, then deploying the stent across the lesion. Fifteen patients (88%) received successful colonic stent placement; 14 (93%) patients achieved decompression within 6 hours. This enabled the presurgical group to undergo elective resection in 2 weeks and enabled the palliative group to decompress and return to their respective care centers for further treatment. Complications included five cases of migration and one death in which a patient received excessive barium enema before successful stent placement. There was a higher incidence of migration in treating extrinsic lesions versus colonic cancer, lesions in the proximal rectosigmoid colon, and those lesions requiring two stents. Migrated stents in the rectum could be retrieved with fluoroscopic techniques. Overall, placement of self-expandable metallic stents for acute colonic obstructions has proven relatively easy and safe to perform with great benefits to the patients allowing them to undergo elective surgical resection and avoiding a temporary colostomy. Newly discovered complications such as migration will need to be addressed. Fluoroscopic-guided colonic stent placement has grown in acceptance in treating both benign and malignant acute colonic occlusions for both palliative and surgical decompression purposes. Seventeen patients underwent self-expandable metallic colonic stent placement. Thirteen patients had acute obstruction requiring surgical decompression. The remaining four patients had stent placement for palliative purposes. Stents were deployed using the standard Tejero-Mainar technique of crossing the lesion with a torquable guidewire and catheter, replacing the wire for a stiff wire, then deploying the stent across the lesion. Fifteen patients (88%) received successful colonic stent placement; 14 (93%) patients achieved decompression within 6 hours. This enabled the presurgical group to undergo elective resection in 2 weeks and enabled the palliative group to decompress and return to their respective care centers for further treatment. Complications included five cases of migration and one death in which a patient received excessive barium enema before successful stent placement. There was a higher incidence of migration in treating extrinsic lesions versus colonic cancer, lesions in the proximal rectosigmoid colon, and those lesions requiring two stents. Migrated stents in the rectum could be retrieved with fluoroscopic techniques. Overall, placement of self-expandable metallic stents for acute colonic obstructions has proven relatively easy and safe to perform with great benefits to the patients allowing them to undergo elective surgical resection and avoiding a temporary colostomy. Newly discovered complications such as migration will need to be addressed.