Self-expanding metallic stent in the treatment of colonic obstruction caused by advanced malignancies

INTRODUCTION: The treatment of malignant obstruction of the left colon or r ectum usually requires emergency surgery on poor-risk; patients, and the cr eation of a stoma is usually inevitable. With the use of self-expanding met allic stents, the prompt relief of large-bowel obstruction without surgery has become possible. This report describes our results in the use of self-e xpanding metallic stents in the treatment of left-sided colonic obstruction resulting from advanced malignancies. METHODS: From November 1997 to March 1999, insertion of self-expanding metallic stents was attempted in 24 pati ents with acute left-sided colonic obstruction caused by primary or recurre nt malignancies. FLU the procedures were performed by colorectal surgeons. The guidewire was inserted through the channel of the endoscope, and its po sition was confirmed with fluoroscopy. Uncovered Wallstent(R) esophageal en doprostheses were used in all except the first case. The insertion and depl oyment of the stents were under both endoscopic and fluoroscopic guidance. RESULTS: There were 24 patients (15 males) with a mean age of 63.6 (range, 36-98) years. Thirteen patients had primary colorectal cancer and 11 had re current cancers (colorectal cancer, 5; gastric cancer, 5; other. 1). In the treatment of primary cororectal cancer, seven procedures were palliative, and no subsequent surgery was planned because of extensive liver metastasis or poor medical risk. The other six patients underwent elective resection after mechanical bowel preparation. There was no mortality related to the p rocedure. Stenting was successful in the relief of obstruction in 23 patien ts. Perforation of the colon occurred in one patient, and an emergency Hart mann's operation was performed. Migration of the stents occurred in three p atients. Only 3 of the 18 patients in the palliation group required the sub sequent creation of stomas. CONCLUSION: The use of the self-expanding metal lic stents can achieve rapid and effective nonsurgical means to relieve lef t-sided colonic obstruction. It provides good palliation for unresectable a dvanced tumors that cause colonic obstruction. It may also have a role in t he temporary relief of obstruction so that subsequent colonic resection can be performed under elective conditions.