Abstract

Background: Self expanding metal stents (SEMS) are effective for palliation of obstruction due to colon cancer. However, very little is known regarding the use of SEMS for colonic obstruction due to extra-colonic malignancies. We retrospectively reviewed our experience with SEMS for palliation of colonic obstruction due to non-colonic malignancies. Methods: Between October 2003 and January 2007, 24 patients had 30 procedures to place 38 SEMS across 31 strictures. All procedures were performed with sedation or general anesthesia, using standard endoscopic techniques under fluoroscopic guidance. Procedural success was defined if three outcomes were achieved: Adequate deployment of a SEMS; adequate palliation of colonic obstruction within a week; and no resultant mortality within a week of the procedure. Results: Twenty patients (83%) were female. The mean age was 60 ± 11 years. Primary neoplasms were ovarian (9), cervical (4), uterine (2), endometrial (2), bladder (3), pancreas (2) and sarcoma (2). Clinically, 58% had partial obstruction, 42% complete obstruction, and 16% had recto-vaginal fistulae. One stricture was seen in 75% of patients, while 25% had two distinct levels of colonic obstruction. Obstruction sites were transverse colon (19%), left colon (66%), and rectum (15%). The stricture lengths were: < 5 cm (33%), 5-10 cm (48%), and > 10 cm (19%). Strictures were categorized as: straight (25%), single severe angulation (33%), or tortuous/multiangled (42%). Balloon dilation was required for 36% of strictures. When successful, 19 strictures required one SEMS, 5 strictures required two SEMS, and 3 strictures required 3 SEMS for adequate luminal patency. A variety of SEMS were used, including: Wallstent enteral, Wallflex colonic, Ultraflex covered esophageal, and Z-stent covered esophageal stents. Twenty of 30 (66%) procedures were successful. Reasons for failure included: 4 strictures could not be stented, 4 patients required a venting gastrostomy or diverting colostomy and 2 expired within a week due to perforation. Three additional patients required a venting gastrostomy or surgery within a month despite patent stents. The incidence of major complications was 13% (2 expired, 2 had respiratory failure). The incidence of pain, stent migration, fever and bleeding was 63%. Conclusions: Endoscopic placement of SEMS for colonic obstruction due to extra-colonic malignancies is an effective method of palliation. However, these complex strictures frequently require more than one SEMS to achieve luminal patency, and may be associated with a significant risk of complications.

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