Experience with endoluminal colonic wall stents for the management of large bowel obstruction for benign and malignant disease

Hypothesis: To assess the applicability and efficacy of endoluminal colonic wall stents (ECWSs) in the management of large bowel obstruction (LBO). Design Inception cohort study. Setting: University-based tertiary medical center. Patients: Eleven consecutive patients with LBO in the absence of peritoniti s. Intervention: Placement of ECWS under endoscopic and fluoroscopic guidance. Main Outcome Measures: The success rate in ECWS placement, the efficacy in decompressing the obstruction, and the patency rate of the ECM'S. Results: Successful placement of ECWSs was obtainable in 10 of 11 patients. Once placed, all 10 patients achieved immediate decompression of their LBO . Eight patients had malignant obstructions associated with distant spread of disease; 3 patients had diverticular disease. Among those with malignant obstruction, 6 patients had successful and lasting palliation without colo stomy, 1 patient underwent 1-stage resection 1 month later with no evidence of obstruction, and 1 patient could not be stented so diversion was done. None of the patients with diverticular disease required diversion: 2 had co mplete bowel preparation followed by resection with primary anastomosis, wh ereas the third declined surgery. Four of the 10 patients required overlapp ing ECWSs to bridge the stricture. One patient required a second ECWS secon dary to recurrence of obstruction after stent migration and has continued p alliation of his stage 4 rectal cancer for the last 11 months. No other com plications were encountered. Conclusions: Urgent surgery with colostomy for LBO was avoided ill 10 of 11 patients because of successful placement of ECWSs. We believe that endosco pic colonic stenting is safe, effective, and lasting, and should be conside red as initial nonoperative management in all patients seen with LBO in the absence of peritonitis.