Self-Expanding Metal Stents in Malignant and Benign Colonic Obstructions

Abstract

Objectives: The use of metal autoexpandable stents in acute colorectal obstruction is appropriate in three different scenarios: with palliative intention, a bridge to facilitate a future operation of definitive character and in benign colorectal stenoses. We describe a prospective follow-up of patients who received colorectal stents in these three situations. Patients and Methods: We present a prospective analysis of the outcome in 20 patients in whom 22 stents were placed (11 men, 55%), between June of 2003 and August 2007. The mean age was 71 years (range 46 to 91). All patients with malignant or benign pathology had symptoms of acute colorectal occlusion. Malignant obstruction was present in 16 patients and benign obstruction in 4 patients. The benign stenoses included ischemic (n = 1), radiation (n = 1) and anastomotic (n = 2). Results: 8 stents were used for palliation, 8 preoperative stents and 4 in benign stenoses. In more proximal stenoses through the scope stents were used and in rectosigmoid stenoses (more distal) peranal stent were used , produced locally with support of Korean technology. There was clinical success in 18 patients (90%). Complications included stent migration (n = 4), obstruction (n = 2) and perforation (n = 2). There was one failure to place a peranal stent in one patient due to descending colon location. All the patients with benign stenoses were treated successfully with the application of the stent avoiding a definitive colostomy. A patient died after a colonic perforation, she didn't accept the surgery. Conclusions: The use of stents as a palliative procedure or as a bridge to surgery is associated with low morbidity, allows bowel preparation, and thus avoids the need for a temporary or definitive colostomy. Long-term patency suggests that stents may lead to avoiding an operation in patients with metastatic disease and further defines their role in the palliation of malignant obstruction and its application in benign pathology is equally encouraging. Further prospective randomized studies are necessary to fully elucidate the use of stents in the management of colorectal cancer and benign colorectal obstructions.