EXPANDABLE METAL STENTS FOR THE TREATMENT OF COLONIC OBSTRUCTION - TECHNIQUES AND OUTCOMES

Background: Acute left-sided colonic obstruction is a surgical emergen cy whose management is controversial. Because experience using expanda ble metal stents for relief of this type of obstruction is limited, we evaluated their effectiveness, feasibility, safety, and outcome. Meth ods: Twenty-five patients with acute colorectal obstruction underwent placement of various metal stents under fluoroscopic and endoscopic gu idance. On an intent-to-treat basis, stents were placed for decompress ion before one-stage surgical resection in 10 patients and palliativel y in 15 patients. Two preoperative patients had unresectable malignant disease, and stents were left for palliation resulting in 17 palliati ve and 10 preoperative patients for analysis. Results: Stent placement was technically successful in 94% of patients. Overall effectiveness in relieving obstruction was 85% (palliative 82%, preoperative 90%). I n the palliative group, stent duration ranged from 2 to 64 weeks (mean 17.3 weeks). Major complications occurred in 7 patients (30%). Conclu sions: Expandable metal stents are a feasible, effective adjunct and a lternative to surgery for acute colorectal obstruction.