Colorectal stenting has been reported as an effective method of relieving colonic obstruction in the palliative setting for advanced cancer and in the preoperative setting as a bridge to surgery. Stenting can allow for an emergency operation to be converted to an elective operation. By decompressing the colon and allowing for medical optimization of the patient, self-expandable metal stent (SEMS) placement can transition a patient from a high-risk situation to a one-stage elective operation with potential primary resection and anastomosis. Stenting of select benign strictures is also accepted. In the hands of experienced advanced endoscopists, the placement of the stent has a high chance of technical and clinical success. In this chapter, we will discuss the indications and contraindications for stenting, types of stents available with advantages and disadvantages, up-to-date literature on success rates, short- and long-term complication rates, and cost. Finally, we will discuss what we feel are technical pearls for successful stenting.
KeywordsColonic stent Self-expandable stent Colon cancer Colon obstruction Colon stenosis Endoscopic Palliation Enteral stent
Video 6.1 Stenting of a malignant rectosigmoid stricture: The endoscope was advanced up to the malignant rectosigmoid stricture. Under endoscopic and fluoroscopic visualization, a ball tip catheter preloaded with a hydrophilic guidewire was used to cross the stricture. The ball tip was then exchanged over the wire for a 15-mm balloon catheter. The balloon catheter was advanced over the wire across the stricture and inflated; injection of contrast confirmed proximal dilation and allowed measurement of the stricture length. Over the guidewire, a 25 × 60-mm uncovered self-expanding metal stent was deployed across the stricture with good decompression (MP4 6286 kb)
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