TREATMENT OF COLONIC OBSTRUCTION WITH EXPANDABLE METAL STENTS - RADIOLOGIC FEATURES

OBJECTIVE. The purpose of this prospective study was to evaluate the e fficacy of expandable metal stents for colonic decompression in patien ts presenting with acute malignant obstruction and to describe the ass ociated radiographic findings. SUBJECTS AND METHODS. Using both fluoro scopic and endoscopic guidance, we placed expandable metal stents with in the colons of 13 patients presenting with acute malignant obstructi on. Stents were placed in four patients to permit a standard bowel cle ansing before surgical resection with primary anastomosis. In the othe r nine patients, stents were placed for palliation of nonresectable tu mors, obviating colostomy. Outcomes and complications were analyzed. T he radiologic aspects of procedural planning, stent placement, assessm ent after placement, and detection of complications were evaluated. RE SULTS. Of the four surgical candidates who were successfully resected with primary anastomosis, two received incomplete bowel cleansing beca use of stent migration with recurrent obstruction. Eight of the nine p atients who had stents placed for palliation of nonresectable tumors h ad relief of acute obstruction. Complications in this group included t wo perforations, one that required immediate colostomy and one that wa s self-limited and conservatively treated. Two other patients of the e ight developed early stent obstruction, requiring colostomy in one. Th e other patient who had a stent placed for palliation of a nonresectab le tumor declined further treatment. contrast-enhanced enema examinati on proved useful in assessing the suitability of lesions for stent dec ompression, directing the choice of stent type and the most appropriat e position for the patient during the stent place ment. Immediately af ter stent placement, plain abdominal radiographs and water-soluble con trast enema examinations helped us verify stent position and patency. CONCLUSION. These results suggest that placement of expandable metal s tents in patients presenting with acute, malignant colonic obstruction is a viable alternative to colostomy and can potentially decrease mor bidity and mortality. Radiologic assessment before, during, and after stent placement plays an integral role in the management of patients u nder going stent decompression of the colon.