Advertisement

Endoscopic treatment of acute colorectal obstruction with self-expandable metallic stents

Experience in a community hospital
  • S. Soto
  • L. López-Rosés
  • A. González-Ramírez
  • A. Lancho
  • A. Santos
  • P. Olivencia
Article

Abstract

Background

The purpose of this study was to evaluate the efficacy and security of treatment with self-expandable metallic stents for acute colonic obstruction.

Methods

Retrospectively, we analyzed our experience in placing colonic stents in patients with acute colonic obstruction. Sixty-two patients with malignant colon obstruction were sent to our hospital endoscopic unit from February 1999 through September 2003. The mean age was 75.21 years. A total of 63 self-expandable metallic stents were implanted. All procedures were done under endoscopic and fluoroscopic guidance.

Results

Technical success was obtained in 58 patients (93.54%). Clinical improvement and resolution of the obstruction were confirmed in 56 of these 58 patients (96.55%) within 48–72 h. Sixteen complications were observed in 11 patients (19%). Twelve cases were minor complications: five patients had pain and rectal tenesmus, and there were seven cases of distal migration of the stent. Four patients (6.9%) had severe complications. Three patients underwent surgery to resolve colonic perforations and one patient developed a colovesical fistula 7 months after stent placement. The stent was used as a bridge to the elective surgery in 22 patients (37.93%). The mean time between stent placement and surgery was 7.66 days (range, 2–20). The stent was used as a definitive palliative treatment in 36 patients (62.07%).

Conclusion

Stenting was a useful treatment of acute malignant colonic obstruction. The use of stents as a “bridge to the elective surgery” allowed the intestinal preparation, general status restoration, and a one-stage operation with resection and primary reanastomosis. We have also used the stents as a definitive palliative treatment, avoiding surgery in those patients with a very widely metastatic disease or who cannot undergo operation because of comorbid underlying conditions.

Keywords

Colorectal Endoscopy Therapeutic Palliation 

References

  1. 1.
    Adamsem S, Holm J, Meissner S, Moller P, Naver LP, West F, Wille- Jorgensen PA (2000) Endoscopic placement of self-expanding metal stents for treatment of colorectal obstruction with long term follow-up. Dan Med Bull 47: 225–227Google Scholar
  2. 2.
    Arnell T, Stamos MJ, Takahasi P, Ojha S, Sze G, Eysselein V (1998) Colonic stents in colorectal obstruction. Am Surg 64: 986–988PubMedGoogle Scholar
  3. 3.
    Baron TH, Dean PA, Yares MR 3rd, Canon C, Koehler RE (1998) Expandable metal stents for treatment of colorectal obstruction: techniques and outcomes. Gastrointest Endosc 47: 277–286PubMedCrossRefGoogle Scholar
  4. 4.
    Baron TH, Rey JF, Spinelli P (2002) Expandable metal stent placement for malignant colorectal obstruction. Endoscopy 1: 823–830CrossRefGoogle Scholar
  5. 5.
    Binkert CA, Ledermann H, Jost R, Saurenmann P, Decurtnis M, Zollikofer CL (1998) Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self expanding metallic stents—a preliminary report. Radiology 206: 199–204PubMedGoogle Scholar
  6. 6.
    Boormann P, Soonawalla Z, Sathanathan N, MacFarlane P, Parkrer MC (1999) Endoluminal stenting of obstructed colorectal tumors. Ann R Coll Surg Engl 81: 251–254Google Scholar
  7. 7.
    Buechter KJ, Boustany C, Caillouette R, Cohn I Jr (1988) Surgical management of the acutely obstructed colon. A review of 127 cases. Am J Surg 156(3 Pt 1): 163–168Google Scholar
  8. 8.
    Camunez F, Echenagusia A, Simo G, Turégano F, Vázquez J, Barreiri- Meiro I (2000) Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation. Radiology 216: 492–497PubMedGoogle Scholar
  9. 9.
    Canon CL, Baron TH, Morgan DE, Dean PA, Koehler RE (1997) Treatment of colonic obstruction with expandable metal stents: radiologic features. Am J Roentgenol 168: 199–205Google Scholar
  10. 10.
    Carty NJ, Corder AP (1992) Which surgery avoids a stoma in treating left-sided colonic obstruction? Results of a postal questionnaire. Ann R Coll Surg Engl 74: 391–394PubMedGoogle Scholar
  11. 11.
    Cwikiel W, Stridbeck H, Trandberg KG, von Holstein CS, Hambraeus G, Lillo-Gil R, Willen R (1993) Malignant esophageal strictures: treatment with self-expanding nitinol stent. Radiology 187: 661–665PubMedGoogle Scholar
  12. 12.
    Davidson R, Sweeney WB (1998) Endoluminal stenting for benign colonic obstruction. Surg Endosc 12: 353–354PubMedCrossRefGoogle Scholar
  13. 13.
    Dohmoto M, Hünerbein M, Schlag M (1997) Application of rectal stents for palliation of obstructing rectosigmoid cancers. Surg Endosc 11: 758–761PubMedCrossRefGoogle Scholar
  14. 14.
    Gandgrup P, Lund L, Balsev I (1992) Surgical treatment of acute malignant large bowel obstruction. Eur J Surg 158: 427–430Google Scholar
  15. 15.
    Itabashi M, Hamamo K, Kameoka S, Asahina K (1993) Self-expanding stainless steel stent application in rectosigmoid stricture. Dis Colon Rectum 36: 508–511PubMedCrossRefGoogle Scholar
  16. 16.
    Keen R, Orsay CH (1992) Rectosigmoid stent for obstructing colonic neoplasm. Dis Colon Rectum 35: 912–911PubMedCrossRefGoogle Scholar
  17. 17.
    Keimling M (2003) Colorectal stenting. Endoscopy 3: 234–238CrossRefGoogle Scholar
  18. 18.
    Knrym K, Wagner HJ, Bethge N, Keimling M, Vakil N (1993) A controlled trial of an expansible metal stent for palliation of oesophageal obstruction due to a inoperable cancer. N Engl J Med 329: 1302–1307CrossRefGoogle Scholar
  19. 19.
    Law WL, Chu KW, Ho JW, Tung HM, Law SY, Chu KM (2000) Self expanding metallic stents in the treatment of colonic obstruction caused by advanced malignancies. Dis Colon Rectum 43: 1522–1527CrossRefPubMedGoogle Scholar
  20. 20.
    Leitman IM, Sullivan JD, Brams D, Decosse JJ (1992) Multivariate analysis of morbidity and mortality from the initial surgical management of obstructing carcinoma of the colon. Surg Gynecol Obstet 174: 513–518PubMedGoogle Scholar
  21. 21.
    López CM, Martínez JMR, Cebrián ET, et al (2001) Treatment of left colon neoplastic obstruction by placement of self-expandable stents. Rev Esp Enferm Dig 93: 232–237Google Scholar
  22. 22.
    López-Costner F, Hool GR, Lavery JC (1997) Management and causes of acute large-bowel obstruction. Surg Clin North Am 77: 1265–1290CrossRefGoogle Scholar
  23. 23.
    Mainar A, de Gregorio Ariza MA, Tejero E, Tobío E, Alfonso E, Pinto I, Herrera M, Fernández JA (1999) Acute colorectal obstruction: treatment with self expandable metallic stents before scheduled surgery—results of a multicenter study. Radiology 210: 65–69PubMedGoogle Scholar
  24. 24.
    Mainar A, Tiger E, Maynar M, Ferral H, Castaneda-Zúñiga W (1996) Colorectal obstruction: treatment with metallic stents. Radiology 198: 761–764PubMedGoogle Scholar
  25. 25.
    Messmer P, Thoni F, Ackermann C, Herzog U, Schuppiser JP, Tondelli P (1992) Perioperative morbidity and mortality of colon resection in colonic carcinoma. Scheveiz Med Wochenschr 122: 1011–1014Google Scholar
  26. 26.
    Murray JJ, Schoetz DJ, Coller JA, Roberts PL, Weidenheimer MC (1991) Intraoperative colonic lavage and primary anastomosis in nonelective colon resection. Dis Colon Rectum 34: 527–531PubMedCrossRefGoogle Scholar
  27. 27.
    Pikarsky AJ, Efron JE, Weiss EG, Eisenberg P, Nogueras JJ, Wexner SD (2000) Overcoming Wallstent malposition in the treatment of rectosigmoid obstruction. Surg Endosc 14: 372PubMedCrossRefGoogle Scholar
  28. 28.
    Raijman I, Siemens M, Marcon N (1995) Use of an expandable ultraflex stent in the treatment of malignant rectal strictures. Endoscopy 27: 273–276PubMedCrossRefGoogle Scholar
  29. 29.
    Repici A, Reggio D, De Angellis C, Barletti C, Marchesa P, Muso A, et al (2000) Covered metal stents for management of inoperable malignant colorectal strictures. Gastrointest Endosc 6: 735–740CrossRefGoogle Scholar
  30. 30.
    Runkel NS, Sohlag P, Schwarz V, Herfarth C (1991) Outcome after emergency surgery for cancer of the large intestine. Br J Surg 78: 113–118Google Scholar
  31. 31.
    Saida Y, Sumiyama, Nagao J, Takase M (1996) Stent endoprotheses for obstructing colorectal cancers. Dis Colon Rectum 39: 552–555PubMedCrossRefGoogle Scholar
  32. 32.
    Tack J, Gevers AM, Rutgeerts P (1998) Self-expandable metallic stents in the palliation of rectosigmoidal carcinoma: a follow-up study. Gastrointest Endosc 3: 267–272CrossRefGoogle Scholar
  33. 33.
    Tiger E, Mainar A, Fernández L, Tieso A, Cuezva JF, San José A (1995) New procedure for relief of malignant obstruction of the left colon. Br J Surg 82: 34–35Google Scholar
  34. 34.
    Tiger E, Mainar A, Fernández L, Tobio R, De Gregorio MA (1994) New procedure for the treatment of the colorectal neoplastic obstructions. Dis Colon Rectum 37: 1158–1159CrossRefGoogle Scholar
  35. 35.
    Tominaga K, Yoshida M, Maetani I, Sakai Y (1998) Expandable metal stent placement in the treatment of a malignant anastomotic stricture in the transverse colon. Gastrointest Endosc 47: 277–285CrossRefGoogle Scholar
  36. 36.
    Turegano-Fuentes F, Echenagusia-Belda A, Simo-Muerza G, Camunez F, Munoz-Jimenez F, Del Valle Hernández E, Quintáns-Rodríguez A (1998) Transanal self-expanding metal stents as an alternative to palliative colostomy in selected patients with malignant obstruction of the left colon. Br J Surg 85: 232–235CrossRefPubMedGoogle Scholar
  37. 37.
    Vandervoort J, Weiss EJ, Sommay K, Tham TCK, Wong RCK, Carr-Locke DL (1996) Self expanding metal stent for obstructing adenocarcinoma of the sigmoid. Gastrointest Endosc 44: 739–741PubMedCrossRefGoogle Scholar
  38. 38.
    Wallis F, Campbell KL, Eremin O, Hussey JK (1998) Self-expanding metal stents in the management of colorectal carcinoma: a preliminary report. Clin Radiol 53: 251–254CrossRefPubMedGoogle Scholar
  39. 39.
    Witzig JA, Morel P, Erne M, Egelli R, Borst F, Rohner A (1993) Chirurgie des cancers digestifs des patients de plus de 80 ans. Helv Chir Acta 59: 767–769PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • S. Soto
    • 1
  • L. López-Rosés
    • 1
  • A. González-Ramírez
    • 1
  • A. Lancho
    • 1
  • A. Santos
    • 1
  • P. Olivencia
    • 1
  1. 1.Gastroenterology UnitHospital Xeral de LugoLugo

Personalised recommendations