Metal stent placement in acute malignant colorectal obstruction

Abstract

Background Obstruction is a common complication of advanced colorectal cancer. Stent insertion can reduce the need for emergency surgery and allows chemotherapy to begin immediately. Aims To evaluate the technical and clinical success and long-term outcome of stent placement in the management of acute malignant colorectal obstruction. Methods From July 2002 to April 2005, 29 self-expanding metal stents were placed in 24 patients (13 men, mean age 67 years, range 36–83). Stents were inserted under endoscopic and fluoroscopic control. Patients were clinically and endoscopically followed up. Results Twenty-eight out of 29 stents were successfully placed (96.5%) in 23 out of 24 patients with 25 strictures. The clinical success rate was 95.8% (23/24). Two early stent migrations were observed in two patients (8.3%). Late complications developed in eight patients (33.3%) after a median of 3.8 months (range <1–8.6): two migrations and six occlusions. The median survival was 9.8 months (range <1–27). Eleven patients (45.8%) died from progressive disease without any clinical evidence of recurrent obstruction. Conclusion Stent placement is safe and effective. Stent complications are frequent but not life-threatening, and are easy to manage. An improvement in stent design and well-scheduled follow-up are needed in order to prevent such complications.