Self Expanding Metal Stents for Malignant Colorectal Obstruction Experience At a Private Hospital in Turkey

Abstract

Background: The treatment of malignant obstruction of the colon or rectum usually requires emergency surgery on poor risk patients and the creation of a stoma is usually inevitable. SEMS have made prompt relief of obstruction without surgery possible. Aims: The purpose of our study was to evaluate the feasibility, effectiveness, safety and outcome in using SEMS to relieve acute colorectal obstruction for two different treatment in tentions, group I; preoperative decompression before surgical resection with primary anastomosis, group II; palliation for patients with inoperable malignant colorectal obstruction. Methods; From July 2003 to July 2006 10 SEMS (enteral wallstents) were placed in 10 patients under fluoroscopic and endoscopic control by a single experienced endoscopist. The data on the nature of pathology, success of the procedure, the complications and the outcomes of the patients were collected prospectively. Results: Nine patients had colorectal cancer, one patient had recurrent inoperable ovarian cancer. The procedure was for palliative intend in 5 patients (50%). Successfull insertion of the stent was achieved in 9 patients (90%). The clinical success rate was 90% . In one patient two stents were placed coaxially and overlapping for a long stricture. Location of the stricture were left colon (6 patients), transvers colon (3), cecum (1), colostomy site (1). In the patient with the obstruction at the level of cecum the stent could not be carried over the guidewire to the stricture site due to a long redundant sigmoid colon. The patient with two overlapping stents had a perforation 5 days after the procedure which was managed surgically. In group one all patients underwent subsequent definitive surgery, one had an ileostomy, mean ICU stay was 1.2 days, mean hospital stay was 7.6 days, no major perioperative complications occured. In group II, the mean survival was 8 months, all the patients died from reasons unrelated to stent obstruction. Conclusions: The use of SEMS for malignant colorectal obstruction is safe and effective. It provides good palliation for unresectable advanced tumors. It may also have a role in the temporary relief of obstruction so that subsequent definitive surgery can be performed under elective conditions. Through the scope technique with a large channel colonoscope rather than carrying the stent over a guidewire under floroscopic control might be preferable for right sided colonic strictures.